TY - JOUR
T1 - The endoscopic assessment of esophagitis
T2 - A progress report on observer agreement
AU - Armstrong, D.
AU - Bennett, J. R.
AU - Blum, A. L.
AU - Dent, J.
AU - De Dombal, F. T.
AU - Galmiche J.-, P.
AU - Lundell, L.
AU - Margulies, M.
AU - Richter, J. E.
AU - Spechler, S. J.
AU - Tytgat, G. N J
AU - Wallin, L.
N1 - Funding Information:
*Department of Medicine, Division of Gastroenterology, McMaster University Medical Center, Hamilton, Ontario, Canada; ‡Remenham House, West Ella, Hull, England; §Division de Gastro-entérologie, Centre Hospitalier, Universitaire Vaudois, Lausanne, Switzerland; xGastroenterology Unit, Royal Adelaide Hospital, Adelaide, Australia; ØClinical Information Science Unit, Leeds, England; #Centre Hospitalier Regional et Universitaire de Nantes, Hôpital G & R Laënnee, Nantes, France; **Department of Surgery, University of Gothenburg, Sahlgren’s Hospital, Gothenburg, Sweden; ‡‡Division of Gastroenterology, Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; §§Department of Medicine, Beth Israel Hospital, Boston, Massachusetts; xxAcademisch Medisch Centrum, Darm-Enleverzeiken, Amsterdam, The Netherlands; and ØØDepartment of Surgical Gastroenterology, KAS, Glostrup, Denmark
PY - 1996
Y1 - 1996
N2 - Background and Aims: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. Methods: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42 endoscopists, including 13 endoscopists in training, assessed 23 endoscopic video recordings. In a third, ancillary study, using a simpler evaluation sheet, 219 gastroenterologists recorded their assessments of 20 still images. Results: The agreement between endoscopists was similar for still images and video recordings. Agreement between experienced endoscopists was acceptable to good for recognition of minimal changes (erythema, friability, mucosal edema; κ = 0.46 to κ = 0.8), mucosal breaks (discretely, demarcated areas of slough or erythema; κ = 0.84), and complications (ulceration, κ = 0.92; structuring, κ = 0.80; columnar metaplasia, κ = 0.81), although there was poor agreement when the circumferential extent and number of mucosal breaks were assessed. However, total circumferential extent of the mucosal break had a κ value of 0.59. Agreement between inexperienced endoscopists was poor for recognition of minimal changes but was good for recognition of complications (κ, 0.70-0.90). Conclusions: Endoscopists can identify mucosal breaks confined to a mucosal fold and lesions that extend throughout the esophageal circumference. Complications of reflux disease can be reproducibly recorded. Criteria for assessing the number of mucosal breaks and their radial extent must be defined more clearly, as must the features of minimal change esophagitis.
AB - Background and Aims: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. Methods: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42 endoscopists, including 13 endoscopists in training, assessed 23 endoscopic video recordings. In a third, ancillary study, using a simpler evaluation sheet, 219 gastroenterologists recorded their assessments of 20 still images. Results: The agreement between endoscopists was similar for still images and video recordings. Agreement between experienced endoscopists was acceptable to good for recognition of minimal changes (erythema, friability, mucosal edema; κ = 0.46 to κ = 0.8), mucosal breaks (discretely, demarcated areas of slough or erythema; κ = 0.84), and complications (ulceration, κ = 0.92; structuring, κ = 0.80; columnar metaplasia, κ = 0.81), although there was poor agreement when the circumferential extent and number of mucosal breaks were assessed. However, total circumferential extent of the mucosal break had a κ value of 0.59. Agreement between inexperienced endoscopists was poor for recognition of minimal changes but was good for recognition of complications (κ, 0.70-0.90). Conclusions: Endoscopists can identify mucosal breaks confined to a mucosal fold and lesions that extend throughout the esophageal circumference. Complications of reflux disease can be reproducibly recorded. Criteria for assessing the number of mucosal breaks and their radial extent must be defined more clearly, as must the features of minimal change esophagitis.
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U2 - 10.1053/gast.1996.v111.pm8698230
DO - 10.1053/gast.1996.v111.pm8698230
M3 - Article
C2 - 8698230
AN - SCOPUS:0029933079
SN - 0016-5085
VL - 111
SP - 85
EP - 92
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -