Intraobserver and interobserver consistency for grading esophagitis with narrow-band imaging.

BACKGROUND Narrow-band imaging (NBI) is a novel, noninvasive optical technique that adjusts reflected light to enhance the contrast between the esophageal mucosa and the gastric mucosa. Whether the use of this optical technique may increase consistency in describing the presence and severity of mucosal breaks remains elusive. OBJECTIVES We compared the intra- and interobserver variations in the endoscopic scoring of esophagitis by using conventional imaging with and without NBI. DESIGN Cross-sectional study of consecutive patients with reflux. SETTING Single center in Taiwan. PATIENTS Endoscopic photographs of 230 patients with gastroesophageal reflux were obtained with both methods. Images were randomly displayed twice to 7 endoscopists, who independently scored each photograph by using the Los Angeles classification. MAIN OUTCOME MEASUREMENTS We calculated intra- and interobserver kappa statistics to measure the consistency in interpretations. RESULTS With the addition of NBI, intraobserver reproducibility significantly improved with 3 of the 7 endoscopists. Interobserver reproducibility was more consistent with the combined approach than with conventional imaging alone, with an improved overall kappa value of 0.62 versus 0.45 (P < .05). Discordance between these methods was substantial in the grading of class A or B esophagitis. LIMITATIONS A small sample of class D esophagitis might have produced insufficient statistical power in this category. CONCLUSIONS Intra- and interobserver reproducibilities in grading esophagitis could be improved when NBI was applied with conventional imaging. The benefit appeared to derive from better depictions of small erosive foci.

[1]  J. Fleiss.  Statistical methods for rates and proportions , 1974 .

[2]  J R Bennett,et al.  The endoscopic assessment of esophagitis: a progress report on observer agreement. , 1996, Gastroenterology.

[3]  Prateek Sharma,et al.  High-resolution chromoendoscopy in the esophagus. , 2004, Gastrointestinal endoscopy clinics of North America.

[4]  Ming-Shiang Wu,et al.  Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: A prospective study based on screening endoscopy , 2006, Journal of gastroenterology and hepatology.

[5]  J. Dent,et al.  Healing and relapse of severe peptic esophagitis after treatment with omeprazole. , 1988, Gastroenterology.

[6]  H. Tajiri,et al.  Magnifying Endoscopy Combined with Narrow Band Imaging System for Early Gastric Cancer: Correlation of Vascular Pattern with Histopathology (including video) , 2004, Endoscopy.

[7]  R. Hunt,et al.  Report of the Asia–Pacific consensus on the management of gastroesophageal reflux disease , 2004, Journal of gastroenterology and hepatology.

[8]  Helmut Messmann,et al.  Comparison of interobserver agreement for different scoring systems for reflux esophagitis: Impact of level of experience. , 2004, Gastrointestinal endoscopy.

[9]  P J Kahrilas,et al.  An evidence-based appraisal of reflux disease management — the Genval Workshop Report , 1998, Gut.

[10]  Masahiro Yamaguchi,et al.  Appearance of enhanced tissue features in narrow-band endoscopic imaging. , 2004, Journal of biomedical optics.

[11]  J. Pandolfino,et al.  Comparison of inter- and intraobserver consistency for grading of esophagitis by expert and trainee endoscopists. , 2002, Gastrointestinal endoscopy.

[12]  Yasushi Sano,et al.  Narrow band imaging: a new diagnostic approach to visualize angiogenesis in superficial neoplasia. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[13]  W. Grove.  Statistical Methods for Rates and Proportions, 2nd ed , 1981 .

[14]  Yasushi Sano,et al.  Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites , 2004, Cancer.

[15]  Gary G. Koch,et al.  Categorical Data Analysis Using The SAS1 System , 1995 .

[16]  A. Blum,et al.  Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification , 1999, Gut.

[17]  R. Fass.  Gastroesophageal reflux disease revisited. , 2002, Gastroenterology clinics of North America.

[18]  H. Toutenburg.  Fleiss, J. L.: Statistical Methods for Rates and Proportions. John Wiley & Sons, New York‐London‐Sydney‐Toronto 1973. XIII, 233 S. , 1974 .

[19]  O. Kawamura,et al.  Interobserver and intraobserver variation in endoscopic assessment of GERD using the "Los Angeles" classification. , 1999, Gastrointestinal endoscopy.

[20]  W. Wong,et al.  Clinical practice pattern of gastroenterologists, primary care physicians, and otolaryngologists for the management of GERD in the Asia–Pacific region: The FAST survey , 2004, Journal of gastroenterology and hepatology.

[21]  Kohzoh Imai,et al.  Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett’s esophagus , 2003, Journal of Gastroenterology.

[22]  A Donner,et al.  Sample size requirements for the comparison of two or more coefficients of inter-observer agreement. , 1998, Statistics in medicine.

[23]  H. Tajiri,et al.  Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. , 2004, Endoscopy.

[24]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[25]  R. Kiesslich,et al.  Inter- and Intra-Observer Variability of Magnification Chromoendoscopy for Detecting Specialized Intestinal Metaplasia at the Gastroesophageal Junction , 2004, Endoscopy.

[26]  T. Havelund,et al.  Interobserver variation in the endoscopic diagnosis of reflux esophagitis. , 1993, Scandinavian journal of gastroenterology.