title: Accuracy and reliability of the endoscopic classification of portal hypertensive gastropathy.
abstract: 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.
authors.affiliation: Department of Medicine and Biostatistics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Hwan Y
authors.initials: HY
authors.lastname: Yoo
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Eustace
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Mary
authors.initials: M
authors.lastname: Harris
authors.forename: Sergey
authors.initials: S
authors.lastname: Kantsevoy
authors.forename: Linda A
authors.initials: LA
authors.lastname: Lee
authors.forename: Anthony N
authors.initials: AN
authors.lastname: Kalloo
authors.forename: William J
authors.initials: WJ
authors.lastname: Ravich
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
mesh_terms: 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