Anatomic classification of the endoscopic appearance of the normal appendiceal orifice: A novel tool for recognition and documentation of cecal intubation

作者：Aslinia Florence M; Bagi Preet; Sorkin John D; Williams Richard B; Knodell Robert G; Sorkin Lawrence F; Greenwald Bruce D; Steele Allison; Raufman Jean Pierre^*

来源：Clinical Anatomy, 2012, 25(4): 496-502.

DOI：10.1002/ca.21276

• quality assurance
• colonoscopy
• classification
• endoscopy
• cecal intubation
• appendiceal orifice
• outcome measures

Complete colonoscopy for cancer screening requires cecal intubation. Failure to reach and examine the cecum may result in missed right colon pathology. We developed and validated a novel classification scheme for the endoscopic appearance of the normal appendiceal orifice (AO). We analyzed 1,456 AO images and grouped them into four categories based on distinguishing features: diverticuloid, umbilicoid, crescent, and linear. An expert panel classified the images and modified these categories, combining crescent and linear categories into curvilinear. A 100-image subset was classified twice by a validation cohort consisting of gastroenterology faculty and fellows. Inter-observer agreement among the expert panel, and intra- and inter-observer agreement among the validation cohort were analyzed using Fleiss' kappa statistic. The distribution of AO images was 67% curvilinear, 19% umbilicoid, and 10% diverticuloid; 85 images (4%) were not classifiable. There was substantial inter-observer agreement among the expert panel (?, 0.72). Inter-observer agreement among the validation cohort was moderate (?, 0.53 and 0.55 for the first and second viewing, respectively). Intra-observer ? values among the validation cohort were 0.69 for the overall classification, 0.65 for diverticuloid, 0.70 for umbilicoid, and 0.70 for curvilinear, indicating substantial agreement. This simple, validated classification scheme for the endoscopic appearance of the normal AO can be used both as a research and clinical tool to measure endoscopic quality, improve cecal examination, and document successful cecal intubation. Clin. Anat. 25:496502, 2012.

• 出版日期2012-5