Korean J Gastrointest Endosc.  2006 Oct;33(4):197-203.

Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease

Affiliations
  • 1Department of Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
  • 2Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 3Department of Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 4Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. leesi96@yumc.yonsei.ac.kr

Abstract

BACKGROUND/AIMS: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients.
METHODS
The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value.
RESULTS
The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402.
CONCLUSIONS
Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups.

Keyword

Gastroesophageal reflux disease; LA classification; Minimal change
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