INTEROBSERVER AGREEMENT OF ENDOSCOPIC ULTRASOUND ASSESSMENT AND MANAGEMENT OF PANCREATIC FLUID COLLECTIONS (PFCS) - AN INTERNATIONAL STUDY

Aims Pancreatic and peripancreatic fluid collections (PFCs) are amongst the most ominous complications of severe acute pancreatitis and in this field Endoscopic Ultrasound (EUS) is emerging as an accurate tool for diagnostic and therapeutic approach. EUS- guided drainage is a common procedure in advanced endoscopic centres but guidelines or specific recommendation are still lacking.

Methods Twelve experts in interventional EUS from 9 European and US tertiary endoscopy centers were invited to evaluate 50 EUS videos of pancreatic fluid collections and were asked to express their opinion on specific details of size, type, morphological signs and therapeutic decision. The primary endpoint was to assess the Interobserver agreement (IA) among endosonographers for EUS diagnosis and classification of PFCs. The secondary endpoint was to evaluate their agreement about endoscopic and non-endoscopic drainage of fluid collections

Results A moderate agreement was found in terms of type of lesion (K= 0.49) while a fair or poor agreement was stated for the presence of infection (K 0.2079), the evaluation of the wall of the PFC, the gut wall visibility, the distance from the PFC and the presence of interposed vessels (k= 0.1372, k =0.0375 and k=0.0557, K = 0.2308 respectively). Wirsung visibility and its communication showed poor agreement (K= 0.0579 and K= 0.1271, respectively). A fair agreement was also stated in terms of treatment (k =0.3976).

Conclusions The diagnosis and management of pancreatic fluid collections by EUS-procedures are still based on single-center experience and there is no a good agreement between expert endosonographers. Futher studies, guidelines and consensus are needed to establish a common evidence-based management in the Western endoscopic centers.