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Yang D, Draganov PV, Pohl H, Aihara H, Jeyalingam T, Khashab M, Liu N, Hasan MK, Jawaid S, Othman M, Al-Haddad M, DeWitt JM, Triggs JR, Wang AY, Bechara R, Sethi A, Law R, Aadam AA, Kumta N, Sharma N, Hayat M, Zhang Y, Yi F, Elmunzer BJ. Development and initial validation of a video-based peroral endoscopic myotomy assessment tool. Gastrointest Endosc 2024; 99:177-185. [PMID: 37500019 DOI: 10.1016/j.gie.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND AIMS Video analysis has emerged as a potential strategy for performance assessment and improvement. We aimed to develop a video-based skill assessment tool for peroral endoscopic myotomy (POEM). METHODS POEM was deconstructed into basic procedural components through video analysis by an expert panel. A modified Delphi approach and 2 validation exercises were conducted to refine the POEM assessment tool (POEMAT). Twelve assessors used the final POEMAT version to grade 10 videos. Fully crossed generalizability (G) studies investigated the contributions of assessors, endoscopists' performance, and technical elements to reliability. G coefficients below .5 were considered unreliable, between .5 and .7 as modestly reliable, and above .7 as indicative of satisfactory reliability. RESULTS After task deconstruction, discussions, and the modified Delphi process, the final POEMAT comprised 9 technical elements. G analysis showed low variance for endoscopist performance (.8%-24.9%) and high interrater variability (range, 63.2%-90.1%). The G score was moderately reliable (≥.60) for "submucosal tunneling" and "myotomy" and satisfactorily reliable (≥.70) for "active hemostasis" and "mucosal closure." CONCLUSIONS We developed and established initial content and response process validity evidence for the POEMAT. Future steps include appraisal of the tool using a wider range of POEM videos to establish and improve the discriminative validity of this tool.
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Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Heiko Pohl
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thurarshen Jeyalingam
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nanlong Liu
- Division of Gastroenterology, University of Louisville, Louisville, Kentucky, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Salmaan Jawaid
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed Al-Haddad
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph R Triggs
- Division of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Robert Bechara
- Division of Gastroenterology and GI Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, Presbyterian Hospital, New York, New York, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Aziz A Aadam
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikhil Kumta
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Maham Hayat
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - YiYang Zhang
- Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA
| | - Fanchao Yi
- Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA
| | - B Joseph Elmunzer
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
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Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, Aadam AA, Triggs JR, Bapaye A, Dorwat S, Benias P, Chaves DM, Barret M, Law RJ, Browers N, Pioche M, Draganov PV, Kotzev A, Estremera F, Albeniz E, Ujiki MB, Callahan ZM, Itani MI, Brewer OG, Khashab MA. Correction to: Comprehensive analysis of adverse events associated with gastric peroral endoscopic myotomy: an international multicenter study. Surg Endosc 2020; 35:1765. [PMID: 32424623 DOI: 10.1007/s00464-020-07651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - K Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - J Jacques
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France
| | - A Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Patel
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J R Triggs
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Bapaye
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - S Dorwat
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - P Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA
| | - D M Chaves
- Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Barret
- Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France.,Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - R J Law
- University of Michigan Health Care System, Ann Arbor, USA
| | - N Browers
- University of Michigan Health Care System, Ann Arbor, USA
| | - M Pioche
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - P V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - A Kotzev
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - F Estremera
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - E Albeniz
- Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M B Ujiki
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Z M Callahan
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - M I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - O G Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. .,Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA.
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Abstract
Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality for superficial esophageal cancer. ESD offers a distinct advantage given the ability to perform en bloc resection enabling accurate histopathologic assessment. Data from published literature has established ESD as the preferred option in the treatment of superficial squamous cell carcinoma with complete resection rates of 78-100%, and a low rate recurrence of 0-2.6%. En bloc resection for esophageal SCC is curative for tumors with M1 (intrapethelial) or M2 (invasion into the lamina propria) involvement with no lymphovascular invasion. Tumors that contain lymphovascular invasion or submucosal invasion greater than 200 μm should be treated as advanced carcinomas due to the increased risk of lymph node metastasis. In contrast, the role of ESD in Barrett's esophagus is more limited due to the high rate of efficacy of EMR. A randomized control trial comparing EMR and ESD strategies found a higher R0 resection rate for ESD, but no significant difference in complete remission from neoplasia at 3 month follow up. Endoscopic ultrasound (EUS) has a limited role in the evaluation of superficial esophageal cancer. Alternatively, detailed endoscopic assessment along with magnification endoscopy or narrow band imaging, may provide greater utility than EUS. The most common adverse events of ESD in the esophagus include perforation and stricture. Perforation can often be managed by defect closure along with non-operative conservative management. Steroid administration with either topical or local injection can be effective management in stricture prevention. Continued refinement of ESD technique and innovation will overcome some of the current limitations of ESD and enable curative resection of superficial esophageal cancer as an alternative to invasive surgery.
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Affiliation(s)
- A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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