Armstrong D, Bennett J R, Blum A L, Dent J, De Dombal F T, Galmiche J P, Lundell L, Margulies M, Richter J E, Spechler S J, Tytgat G N, Wallin L
Department of Medicine, Division of Gastroenterology, McMaster University Medical Center, Hamilton, Ontario, Canada.
Gastroenterology. 1996 Jul;111(1):85-92. doi: 10.1053/gast.1996.v111.pm8698230.
BACKGROUND & AIMS: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis.
Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42 endoscopists, including 13 endoscopists in training, assessed 23 endoscopic video recordings. In a third, ancillary study, using a simpler evaluation sheet, 219 gastroenterologists recorded their assessments of 20 still images.
The agreement between endoscopists was similar for still images and video recordings. Agreement between experienced endoscopists was acceptable to good for recognition of minimal changes (erythema, friability, mucosal edema; kappa = 0.46 to kappa = 0.8), mucosal breaks (discretely, demarcated areas of slough or erythema; kappa = 0.84), and complications (ulceration, kappa = 0.92; stricturing, kappa = 0.80; columnar metaplasia, kappa = 0.81), although there was poor agreement when the circumferential extent and number of mucosal breaks were assessed. However, total circumferential extent of the mucosal break had a kappa value of 0.59. Agreement between inexperienced endoscopists was poor for recognition of minimal changes but was good for recognition of complications (kappa, 0.70-0.90).
Endoscopists can identify mucosal breaks confined to a mucosal fold and lesions that extend throughout the esophageal circumference. Complications of reflux disease can be reproducibly recorded. Criteria for assessing the number of mucosal breaks and their radial extent must be defined more clearly, as must the features of minimal change esophagitis.
反流性食管炎的研究与管理需要一个基于可重复性识别的食管病变的内镜分类系统。本研究的目的是调查观察者之间对反流性食管炎典型内镜病变识别的一致性。
获得观察者描述的配对比较结果。17名内镜医师评估了100张静态图像，42名内镜医师（包括13名实习内镜医师）评估了23段内镜视频记录。在第三项辅助研究中，219名胃肠病学家使用更简单的评估表记录了他们对20张静态图像的评估。
内镜医师之间对静态图像和视频记录的一致性相似。经验丰富的内镜医师之间对于识别微小变化（红斑、易脆性、黏膜水肿；kappa值=0.46至kappa值=0.8）、黏膜破损（离散的、界限分明的脱落或红斑区域；kappa值=0.84）以及并发症（溃疡，kappa值=0.92；狭窄，kappa值=0.80；柱状上皮化生，kappa值=0.81）的一致性为可接受至良好，尽管在评估黏膜破损的周向范围和数量时一致性较差。然而，黏膜破损的总周向范围的kappa值为0.59。经验不足的内镜医师之间对于识别微小变化的一致性较差，但对于识别并发症的一致性良好（kappa值，0.70 - 0.90）。
内镜医师能够识别局限于黏膜皱襞的黏膜破损以及延伸至食管全周的病变。反流性疾病的并发症能够被可重复性记录。评估黏膜破损数量及其径向范围的标准以及微小变化性食管炎的特征必须更明确地界定。
