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Background <p>Accurate size estimation of large (≥ 20&#xa0;mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of visual LST size assessment among endoscopists has not been systematically evaluated.</p> Patients and Methods <p>46 LSTs were recorded during colonoscopy. Twenty-four international expert endoscopists independently reviewed de-identified videos and provided visual estimates for (1) maximal diameter, (2) oral–anal axis, (3) left–right axis, and (4) percentage of colonic circumference involved. Each lesion was assessed twice in randomized order. Fleiss’s kappa, Krippendorff’s alpha, and intraclass correlation coefficients (ICC) were used to evaluate inter- and intra-rater agreement.</p> Results <p>A total of 1104 measurements were collected. Inter-endoscopist kappa agreement for maximal diameter was poor (<i>κ</i> = 0.16), with similarly poor agreement for the oral–anal (<i>κ</i> = 0.15) and left–right axes (<i>κ</i> = 0.14). The percentage of circumferential involvement demonstrated moderate reproducibility (ICC 0.74 and 0.70 across rounds). Subgroup analyses showed consistently poor agreement for larger lesions for diameter-based methods, whereas circumferential percentage estimation ranged from poor to good depending on LST size and morphology. Intra-endoscopist agreement for diameter- and axis-based approaches showed wide variability (<i>κ</i> range 0.01–0.67), while circumferential estimates achieved good to excellent agreement for most endoscopists.</p> Conclusions <p>Visual estimation of large colorectal LST size is highly variable among expert endoscopists. Maximal diameter and axial lengths demonstrate poor inter- and intra-observer reliability. Circumferential extent is the most reproducible descriptor and may be the preferred approach for reporting LST size in clinical practice and research.</p>

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Expert Endoscopist Agreement for Size Measurement of Large (> 2 cm) Colorectal Laterally Spreading Tumors: A Prospective Video-Based Study

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Roupen Djinbachian,
  • Jérémie Jacques,
  • Victoire Michal,
  • Ludovico Alfarone,
  • Robert Bechara,
  • Nicholas G. Burgess,
  • Mariana Figueiredo,
  • Yusuke Fujiyoshi,
  • Lucile Heroin,
  • Michal F. Kaminski,
  • Eric Lam,
  • Philippe Leclercq,
  • Isabelle Lienhart-Chambon,
  • Alexandru Lupu,
  • Charles Menard,
  • Jeffrey Mosko,
  • Nima Mottacki,
  • Heiko Pohl,
  • Douglas K. Rex,
  • Enrique Rodriguez De Santiago,
  • Yutaka Saito,
  • Amrita Sethi,
  • Sandro Sferazza,
  • Neal Shahidi,
  • Daniel von Renteln,
  • Dennis Yang,
  • Mathieu Pioche

摘要

Background

Accurate size estimation of large (≥ 20 mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of visual LST size assessment among endoscopists has not been systematically evaluated.

Patients and Methods

46 LSTs were recorded during colonoscopy. Twenty-four international expert endoscopists independently reviewed de-identified videos and provided visual estimates for (1) maximal diameter, (2) oral–anal axis, (3) left–right axis, and (4) percentage of colonic circumference involved. Each lesion was assessed twice in randomized order. Fleiss’s kappa, Krippendorff’s alpha, and intraclass correlation coefficients (ICC) were used to evaluate inter- and intra-rater agreement.

Results

A total of 1104 measurements were collected. Inter-endoscopist kappa agreement for maximal diameter was poor (κ = 0.16), with similarly poor agreement for the oral–anal (κ = 0.15) and left–right axes (κ = 0.14). The percentage of circumferential involvement demonstrated moderate reproducibility (ICC 0.74 and 0.70 across rounds). Subgroup analyses showed consistently poor agreement for larger lesions for diameter-based methods, whereas circumferential percentage estimation ranged from poor to good depending on LST size and morphology. Intra-endoscopist agreement for diameter- and axis-based approaches showed wide variability (κ range 0.01–0.67), while circumferential estimates achieved good to excellent agreement for most endoscopists.

Conclusions

Visual estimation of large colorectal LST size is highly variable among expert endoscopists. Maximal diameter and axial lengths demonstrate poor inter- and intra-observer reliability. Circumferential extent is the most reproducible descriptor and may be the preferred approach for reporting LST size in clinical practice and research.