title: Non-variceal upper gastrointestinal bleeding and Forrest's classification: diagnostic agreement between endoscopists from the same area.
abstract: OBJECTIVE
  The lack of uniformity in defining the stigmata of hemorrhage in patients with bleeding ulcers is suggested by the wide range among published studies in prevalence and rebleeding rates for the same stigmata. Moreover there is, in published trials of endoscopic hemostasis, little standardization of definitions of stigmata of hemorrhage. The aim of this study was to assess the interobserver agreement among endoscopists from the same area (Piedmont and Valley of Aosta).
  
  
  METHODS
  A workshop for 47 expert endoscopists was organized in order to evaluate their agreement in the diagnosis of stigmata of recent hemorrhage, according to Forrest's classification. During the meeting 25 videotapes from endoscopic examinations of patients with recent non-variceal bleeding were shown to the 47 endoscopists, who were asked to classify every lesion.
  
  
  RESULTS
  The overall and beyond chance interobserver agreement was calculated by means of the kappa statistic. The overall agreement among endoscopists was highly significant (p < 0.001, kappa=0.60), while the beyond chance agreement varied from excellent to good for lesions with active bleeding (kappa=0.76 and kappa=0.61 for FIA and FIB lesions respectively), whereas for lesions with stigmata of recent hemorrhage kappa varied from 0.44 to 0.49.
  
  
  CONCLUSIONS
  These data suggest the need for better knowledge of endoscopic criteria, in order to evaluate the results of endoscopic therapy and to assess new treatments.
authors.affiliation: Dept. of Gastroenterology, Azienda Ospedaliera San Giovanni Battista, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mondardini
authors.forename: C
authors.initials: C
authors.lastname: Barletti
authors.forename: G
authors.initials: G
authors.lastname: Rocca
authors.forename: A
authors.initials: A
authors.lastname: Garripoli
authors.forename: A
authors.initials: A
authors.lastname: Sambataro
authors.forename: C
authors.initials: C
authors.lastname: Perotto
authors.forename: A
authors.initials: A
authors.lastname: Repici
authors.forename: A
authors.initials: A
authors.lastname: Ferrari
mesh_terms: D004493:Education; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015588:Observer Variation; D010438:Peptic Ulcer Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology