Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease

Korean J Gastrointest Endosc > Volume 33(4); 2006 > Article

Korean Journal of Gastrointestinal Endoscopy 2006;33(4): 197-203.

위식도 역류질환의 내시경 진단에서 관찰자 간 차이

이준행·이종수·이풍렬·전훈재*·최명규^†·박영태*·김동기^‡·송기준^‡·이상인^§

성균관대학교 의과대학 내과학교실, *고려대학교 의과대학 내과학교실, ^†가톨릭대학교 의과대학 내과학교실, 연세대학교 의과대학 ^‡의학통계학교실, ^§내과학교실

Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease

Jun Haeng Lee, M.D., Jong-Soo Lee, M.D., Poong-Lyul Rhee, M.D., Hoon Jai Chun, M.D.*, Myung-Gyu Choi, M.D.^†, Young-Tae Bak, M.D.*, Dongkee Kim, M.D.^‡, Kijun Song, M.D.^‡ and Sang In Lee, M.D.^§

Department of Medicine, Sungkyunkwan University School of Medicine, Suwon, *Department of Internal Medicine, Korea University College of Medicine, Seoul, ^†Department of Medicine, The Catholic University of Korea College of Medicine, Seoul, Departments of ^‡Biostatistics, ^§Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background/Aims:
A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients.
Methods:
The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value.
Results:
The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402.
Conclusions:
Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups. (Korean J Gastrointest Endosc 2006;33:197⁣203)

Key Words: Gastroesophageal reflux disease, LA classification, Minimal change

주요어: 위식도 역류질환, LA 분류, 미세변화