P1048 - Inter-Observer Agreement on Debris Assessment and Stent Selection for Drainage in Walled-off Pancreatic Necrosis by Endoscopic Ultrasound

Partha Pal, MD, DNB, MRCP (UK), Sundeep Lakhtakia, MD, DM, Nitin Jagtap, MD, DNB, Shujaath Asif. M, MD, DM, Jahangeer Basha, MD, DM, Aniruddha Pratap Singh, MD, DM, Azimudin Haja, MD, DM, Krithikrishna Koduri, MD, Radhika Chavan, MD, DNB, Raghavendra Yarlagadda, MD, DM, Zaheer Nabi, MD, DNB, Rakesh Kalpala, MD, DNB, Mohan Ramchandani, MD, DM, Rajesh Gupta, MD, DM, D Nageshwar Reddy, MD, DM
Asian Institute of Gastroenterology, Hyderabad, Telangana, India

Introduction: The amount of necrotic content or debris in walled of pancreatic necrosis (WOPN) assessed by endoscopic ultrasound (EUS) is often used to guide stent type (plastic versus metal) for EUS-guided drainage of WOPN. However, a validated classification is lacking for EUS assessment of debris in WOPN and consequent therapeutic intervention. We performed an inter-observer agreement study among endosonographers assessing EUS based debris assessment and choice of stent.

Methods: Fifteen EUS videos of WOPN with paired magnetic resonance imaging (MRI) assessment of debris were selected. These videos were independently reviewed by 40 endosonographers for evaluation of percentage of solid component (categories : < 10%, 10-20%, 20-30%, 30-40%, 40-50%, 50-60%, 60-70%, 70-80%, >80%) and stent choice for drainage (plastic versus metal). The Fleiss’ Kappa (κ)coefficient was used to assess inter-observer agreement. Post hoc analysis was done for agreement on debris content using wider intervals (< 20%, 20-40%, 40-60%, 60-80%, >80%).

Results: The agreement between reference EUS and MRI measurement of solid debris was good (interclass correlation coefficient : 0.797, 95% CI: 0.394-0.932) with moderate correlation (r=0.688). A poor agreement was found for percentage of solid component (κ-0.188). Fair agreement (κ- 0.266) with MRI on percentage of solid debris was noted (Figure 1). The level of agreement (Fleiss’ Kappa, 0.196) did not improve for percentage of solid component even after including endsonographers with more than 10 years experience(n=33). On post-hoc analysis, the inter-observer agreement (κ-0.293, fair agreement) and agreement with MRI (κ-0.456, moderate agreement) improved as the debris intervals were widened from 10% to 20% (Table 1).
Level of agreement for stent selection between a plastic versus metal stent was poor (κ-0.174) which did not improve when only respondents with more than 25 EUS guided drainage per year (n=21) were included (κ- 0.153) or more than 10 years experience (n=33) (κ-0.195) (Figure 1B)

Discussion: Inter-observer agreement between endosonographers regarding assessment percentage of solid debris in WOPN and subsequent choice of stent for drainage is poor. Future studies to standardize the EUS criteria for assessment of solid debris substantiated by paired EUS and MRI study is warranted. Choice of stent for WOPN is largely operator dependent and needs further comparative studies prior to standardization of endoscopic therapeutic approaches.




Disclosures:


Partha Pal, MD, DNB, MRCP (UK), Sundeep Lakhtakia, MD, DM, Nitin Jagtap, MD, DNB, Shujaath Asif. M, MD, DM, Jahangeer Basha, MD, DM, Aniruddha Pratap Singh, MD, DM, Azimudin Haja, MD, DM, Krithikrishna Koduri, MD, Radhika Chavan, MD, DNB, Raghavendra Yarlagadda, MD, DM, Zaheer Nabi, MD, DNB, Rakesh Kalpala, MD, DNB, Mohan Ramchandani, MD, DM, Rajesh Gupta, MD, DM, D Nageshwar Reddy, MD, DM. P1048 - Inter-Observer Agreement on Debris Assessment and Stent Selection for Drainage in Walled-off Pancreatic Necrosis by Endoscopic Ultrasound, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.