Advanced

Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study

Haraldsson, E; Lundell, Lars; Swahn, F. LU ; Enochsson, L; Löhr, J. M.; Arnelo, U; Aabakken, Lars; Grönroos, Juha; Halttunen, Jorma and Hauge, Truls LU , et al. (2017) In United European Gastroenterology Journal 5(4). p.504-510
Abstract

Background: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. Objective: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. Methods: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features,... (More)

Background: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. Objective: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. Methods: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, ‘classic appearance’; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. Results: Interobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58–0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59–0.72). Conclusion: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Duodenoscopy, endoscopic classification, endoscopic retrograde cholangio-pancreaticography, interobserver agreement, intraobserver agreement, papilla of Vater
in
United European Gastroenterology Journal
volume
5
issue
4
pages
504 - 510
external identifiers
  • scopus:85019629939
  • wos:000402000900007
ISSN
2050-6406
DOI
10.1177/2050640616674837
language
English
LU publication?
yes
id
a02c99c4-175d-44c2-bdaa-e03246b65862
date added to LUP
2017-06-19 11:31:28
date last changed
2017-09-18 11:42:01
@article{a02c99c4-175d-44c2-bdaa-e03246b65862,
  abstract     = {<p>Background: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. Objective: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. Methods: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, ‘classic appearance’; (b) Type 2: small papilla, often flat, with a diameter ≤ 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. Results: Interobserver agreement was substantial (κ = 0.62, 95% confidence interval (CI) 0.58–0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (κ = 0.66, 95% CI 0.59–0.72). Conclusion: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter- and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.</p>},
  author       = {Haraldsson, E and Lundell, Lars and Swahn, F. and Enochsson, L and Löhr, J. M. and Arnelo, U and Aabakken, Lars and Grönroos, Juha and Halttunen, Jorma and Hauge, Truls and Lindkvist, Björn and Kylänpää, Marja Leena and Schmidt, Palle N and Saarela, Arto and Toth, Ervin and , },
  issn         = {2050-6406},
  keyword      = {Duodenoscopy,endoscopic classification,endoscopic retrograde cholangio-pancreaticography,interobserver agreement,intraobserver agreement,papilla of Vater},
  language     = {eng},
  month        = {06},
  number       = {4},
  pages        = {504--510},
  series       = {United European Gastroenterology Journal},
  title        = {Endoscopic classification of the papilla of Vater. Results of an inter- and intraobserver agreement study},
  url          = {http://dx.doi.org/10.1177/2050640616674837},
  volume       = {5},
  year         = {2017},
}