Intraobserver and interobserver consistency for grading esophagitis with narrow-band imaging.
BACKGROUND
Narrow-band imaging (NBI) is a novel, noninvasive optical technique that adjusts reflected light to enhance the contrast between the esophageal mucosa and the gastric mucosa. Whether the use of this optical technique may increase consistency in describing the presence and severity of mucosal breaks remains elusive.


OBJECTIVE
We compared the intra- and interobserver variations in the endoscopic scoring of esophagitis by using conventional imaging with and without NBI.


METHODS
Cross-sectional study of consecutive patients with reflux.


METHODS
Single center in Taiwan.


METHODS
Endoscopic photographs of 230 patients with gastroesophageal reflux were obtained with both methods. Images were randomly displayed twice to 7 endoscopists, who independently scored each photograph by using the Los Angeles classification.


METHODS
We calculated intra- and interobserver kappa statistics to measure the consistency in interpretations.


RESULTS
With the addition of NBI, intraobserver reproducibility significantly improved with 3 of the 7 endoscopists. Interobserver reproducibility was more consistent with the combined approach than with conventional imaging alone, with an improved overall kappa value of 0.62 versus 0.45 (P < .05). Discordance between these methods was substantial in the grading of class A or B esophagitis.


CONCLUSIONS
A small sample of class D esophagitis might have produced insufficient statistical power in this category.


CONCLUSIONS
Intra- and interobserver reproducibilities in grading esophagitis could be improved when NBI was applied with conventional imaging. The benefit appeared to derive from better depictions of small erosive foci.
Lee
Yi-Chia
YC
Department of Internal Medicine, College of Medicine, Institute of Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Lin
Jaw-Town
JT
Chiu
Han-Mo
HM
Liao
Wei-Chih
WC
Chen
Chien-Chuan
CC
Tu
Chia-Hung
CH
Tai
Chi-Ming
CM
Chiang
Tsung-Hsien
TH
Chiu
Yueh-Hsia
YH
Wu
Ming-Shiang
MS
Wang
Hsiu-Po
HP
D004941:Esophagitis / Q000145:classification / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology; D015588:Observer Variation; D014741:Video Recording