Section of Gastroenterology/Hepatology, Georgia Health Sciences University, Augusta, GA 30912, USA.
J Clin Gastroenterol. 2013 Feb;47(2):e12-6. doi: 10.1097/MCG.0b013e3182557099.
To evaluate interobserver variability among 4 new physician users on measures of esophageal body function.
Esophageal high-resolution manometry allows observation of esophageal motility by pressure topography plots. Little is known about the interobserver variability among physicians.
Two resident and 2 fellow level physicians each interpreted 10 liquid swallows of 20 esophageal high-resolution manometry studies (n = 200 swallows) using the BioVIEW Analysis Suite (Sandhill Scientific Inc.). Studies evaluated were from patients referred for evaluation of dysphagia but found to have normal esophageal manometry and complete liquid bolus transit. Physicians received an orientation session and reviewed recent literature. Each physician recorded contractile front velocity (CFV) and distal contractile integral (DCI) for each liquid swallow.
Interobserver agreements for CFV and DCI were assessed by intraclass correlation (ICC) values. Linear correlations between measurements by 2 readers were assessed using linear regression modeling techniques.
CFV and DCI values of up to 200 data points were analyzed. Four reader results for CFV and DCI showed strong agreement although stronger for DCI measures (ICC = 0.94; range, 0.91 to 0.98) in comparison with CFV (ICC = 0.79; range, 0.52 to 0.82). Further correlation was performed with 2 readers; readers 1 and 2 revealed excellent correlation for DCI (r = 0.95, P < 0.001) and good correlation for CFV (r = 0.61, P < 0.001).
With a thorough orientation session, good to excellent agreement for CFV and DCI measurements can be obtained from new physician users. CFV measures exhibit greater interobserver variability possibly due to the artifact produced by intraesophageal pressurization.
评估 4 名新医生使用者在食管体功能测量方面的观察者间变异性。
食管高分辨率测压允许通过压力地形图观察食管动力。关于医生之间的观察者间变异性知之甚少。
2 名住院医师和 2 名研究员级医生每人分别使用 BioVIEW 分析套件（Sandhill Scientific Inc.）解释了 20 项食管高分辨率测压研究中的 10 项液体吞咽（n = 200 次吞咽）。评估的研究来自因吞咽困难而被转诊的患者，但发现食管测压正常且完整的液体 bolus 通过。医生接受了一次定位会议并复习了最新文献。每位医生记录了每个液体吞咽的收缩前沿速度（CFV）和远端收缩积分（DCI）。
使用组内相关系数（ICC）值评估 CFV 和 DCI 的观察者间一致性。使用线性回归建模技术评估两位读者之间的测量值之间的线性相关性。
分析了高达 200 个数据点的 CFV 和 DCI 值。CFV 和 DCI 的四个读者结果显示出较强的一致性，尽管 DCI 测量值（ICC = 0.94；范围，0.91 至 0.98）比 CFV（ICC = 0.79；范围，0.52 至 0.82）更强。与 2 位读者进行了进一步的相关性分析；读者 1 和 2 发现 DCI 的相关性非常好（r = 0.95，P < 0.001），CFV 的相关性良好（r = 0.61，P < 0.001）。
经过全面的定位会议，新医生使用者可以获得 CFV 和 DCI 测量值的良好到极好的一致性。CFV 测量值的观察者间变异性更大，可能是由于食管内加压产生的伪影所致。
