Calès P, Zabotto B, Meskens C, Caucanas J P, Vinel J P, Desmorat H, Fermanian J, Pascal J P
Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Purpan, Toulouse, France.
Gastroenterology. 1990 Jan;98(1):156-62.
Nowadays, gastroesophageal endoscopic features of portal hypertension are the recognized predictive factors for bleeding and consequently allow the selection of patients for prophylactic therapies. The aim of this prospective study was to investigate the interobserver agreement, the interassociations between these features, and the relationship between these signs and the degree of hepatic dysfunction. In 100 consecutive cirrhotic patients (84% with alcoholism) without history of digestive bleeding, gastroesophageal endoscopic examination was performed and recorded using a videoendoscope. Four independent observers evaluated the following endoscopic features: the size, extent, color, and red signs of esophageal varices, the mosaic pattern, congestive gastropathy, fundic varices, and associated lesions of the stomach. Agreement was assessed using kappa statistics (kappa) and a quantitative score. The size of esophageal varices was significantly associated with their extent and the presence of red signs, whereas no relation was found either between gastropathy or mosaic pattern and fundic varices, or between esophageal and gastric features. Agreement between observers was good for the size of esophageal varices (kappa = 0.59), the presence of red signs (kappa = 0.60), and of gastric-associated lesions (kappa = 0.68) and gastropathy (kappa = 0.50), while it was poor for the extent (kappa = 0.37) and the color (kappa = 0.28) of esophageal varices as well as for the mosaic pattern (kappa = 0.38). The Child-Pugh score significantly increased along with the presence or the size of esophageal varices as well as with the presence of red signs; no relationship could be shown between this score and the presence of gastric features. We conclude that (1) interobserver agreement was good for the main endoscopic features, especially for the size and the red signs of esophageal varices; (2) esophageal patterns were significantly associated between themselves and related to hepatic dysfunction; and (3) gastric patterns were related neither to esophageal features nor to hepatic dysfunction and were not associated between themselves.
如今，门静脉高压的胃食管内镜特征是公认的出血预测因素，因此可用于选择接受预防性治疗的患者。这项前瞻性研究的目的是调查观察者间的一致性、这些特征之间的相互关联，以及这些体征与肝功能障碍程度之间的关系。对100例无消化性出血病史的连续肝硬化患者（84%为酒精性肝硬化）进行了胃食管内镜检查，并用视频内镜进行记录。四名独立观察者评估了以下内镜特征：食管静脉曲张的大小、范围、颜色和红色征，胃黏膜镶嵌征、充血性胃病、胃底静脉曲张及胃部相关病变。采用kappa统计量（kappa）和定量评分评估一致性。食管静脉曲张的大小与其范围及红色征的存在显著相关，而胃病或胃黏膜镶嵌征与胃底静脉曲张之间，以及食管和胃部特征之间均未发现相关性。观察者间对食管静脉曲张大小（kappa = 0.59）、红色征的存在（kappa = 0.60）、胃部相关病变的存在（kappa = 0.68）和胃病（kappa = 0.50）的一致性良好，而对食管静脉曲张的范围（kappa = 0.37）、颜色（kappa = 0.28）以及胃黏膜镶嵌征（kappa = 0.38）的一致性较差。Child-Pugh评分随食管静脉曲张的存在或大小以及红色征的出现而显著升高；该评分与胃部特征的存在之间未显示出相关性。我们得出结论：（1）观察者间对主要内镜特征的一致性良好，尤其是食管静脉曲张的大小和红色征；（2）食管特征之间显著相关且与肝功能障碍有关；（3）胃部特征与食管特征及肝功能障碍均无关，且它们之间也无关联。
