Accuracy and reliability of the endoscopic classification of portal hypertensive gastropathy.
BACKGROUND
There is no consensus regarding the endoscopic classification of the severity of portal hypertensive gastropathy. This study compared the accuracy and reproducibility of the 2-category classification system (2-CCS) with the 3-category classification system (3-CCS).


METHODS
Ninety-eight endoscopic pictures of portal hypertensive gastropathy and 22 of nonspecific gastritis were selected. Eight duplicate sets were generated, each in a different random order. These were shown to 6 experienced endoscopists during 2 sessions 1 week apart with 4 slide sets at each session. Each picture was scored by using either the 2-CCS or 3-CCS. Kappa statistics and percent agreement were used to estimate the reproducibility and agreement.


RESULTS
The mean percentage agreement among the 4 separate readings for each observer was significantly lower for the 3-CCS compared with the 2-CCS (mean [standard deviation] = 33.5% [8.9%] vs. 64.9% [9.1%]; p = 0.0001). The mean (SD) interobserver kappa values were 0.44 (0.03) for the 3-CCS and 0.52 (0.04) for the 2-CCS (p = 0.02), and the respective intraobserver kappa values were 0.43 (0.1) and 0.63 (0.06) (p = 0.002).


CONCLUSIONS
Even though both the 2-CCS and 3-CCS have substantial limitations with regard to specificity and reliability, there were better agreement and reproducibility with the simpler classification system for portal hypertensive gastropathy.
Yoo
Hwan Y
HY
Department of Medicine and Biostatistics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Eustace
Joseph A
JA
Verma
Sumita
S
Zhang
Lin
L
Harris
Mary
M
Kantsevoy
Sergey
S
Lee
Linda A
LA
Kalloo
Anthony N
AN
Ravich
William J
WJ
Thuluvath
Paul J
PJ
D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D006975:Hypertension, Portal / Q000145:classification* / Q000175:diagnosis; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index