Bytzer P, Havelund T, Hansen J M
Dept. of Medical Gastroenterology S, Odense University Hospital, Denmark.
Scand J Gastroenterol. 1993 Feb;28(2):119-25. doi: 10.3109/00365529309096057.
The interobserver variation among three experienced endoscopists in the endoscopic diagnosis and grading of reflux esophagitis was investigated in 150 dyspeptic patients. The interobserver variation was analyzed with kappa statistics to correct for the extent of agreement expected by chance alone. The observers diagnosed esophagitis in 22.7%, 32.7%, and 35.3% of the patients, respectively (p < 0.0002). Kappa values for grade-1 esophagitis varied from 0.34 to 0.47, a level generally considered to signify poor agreement, and despite partial agreement on the diagnosis in the individual patient there was almost complete disagreement on the features used to characterize grade 1. Kappa values for diagnosing erosive esophagitis (grades 2-4) were 0.68-0.79. Considering all three observers and all grades of esophagitis (grades 0-4) the overall chance-corrected agreement was 0.55. In patients with low-grade esophagitis without reflux-like dyspepsia and when the observers expressed uncertainty in the diagnosis, the agreement rates were particularly poor. Due to a large chance-corrected interobserver variation, the endoscopic diagnosis grade 1 esophagitis is not reliable and thus may be problematic as a selection criterion for clinical trials. Interobserver variation on the presence of erosive/ulcerative esophagitis is acceptable and comparable to the level for peptic ulcer.
在150例消化不良患者中，研究了三位经验丰富的内镜医师在反流性食管炎内镜诊断及分级方面的观察者间差异。采用kappa统计分析观察者间差异，以校正仅由机遇所致的一致程度。观察者诊断食管炎的患者比例分别为22.7%、32.7%和35.3%（p<0.0002）。1级食管炎的kappa值在0.34至0.47之间，该水平通常被认为表示一致性较差，尽管在个体患者的诊断上有部分一致，但在用于表征1级的特征方面几乎完全不一致。诊断糜烂性食管炎（2 - 4级）的kappa值为0.68 - 0.79。考虑所有三位观察者及食管炎的所有分级（0 - 4级），总体校正机遇后的一致性为0.55。在无反流样消化不良的轻度食管炎患者中，以及当观察者对诊断表示不确定时，一致率特别低。由于观察者间校正机遇后的差异较大，内镜诊断1级食管炎不可靠，因此作为临床试验的选择标准可能存在问题。糜烂性/溃疡性食管炎存在情况的观察者间差异是可接受的，且与消化性溃疡的水平相当。
