title: Education can improve inter-observer agreement in double balloon endoscopy assessment.
abstract: OBJECTIVE
  Double balloon endoscopy (DBE) diagnoses are difficult because of the frequent occurrence of tiny lesions or longitudinally arranged erythema, which may result from true pathologies or contact trauma during DBE insertion. This study was performed to explore interobserver agreement for DBE assessment and to determine whether this can be improved by educating endoscopists.
  
  
  METHODS
  Three experienced endoscopists independently evaluated DBE pictures of an initial training set, consisting of 124 lesions in 78 patients with suspected small bowel bleeding. Each endoscopist made DBE diagnoses independently and assessed whether each lesion was or was not a source of bleeding. Tiny lesions were assessed twice, assuming they had been detected during DBE insertion and/or DBE withdrawal. After two sessions of consensus review by the endoscopists, they evaluated a second, validation set consisting of an additional 43 lesions in 30 patients.
  
  
  RESULTS
  Inter-observer agreement with respect to DBE assessment was moderate in the initial training set, but improved to good in the second validation set. The proportion of diagnoses changed to DBE contact lesions when they were assumed to be detected during DBE withdrawal decreased in the second validation set.
  
  
  CONCLUSIONS
  Although inter-observer agreement for DBE assessment is not excellent, it can be improved by education of endoscopists.
authors.affiliation: Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Yang
authors.forename: Soon Man
authors.initials: SM
authors.lastname: Yoon
authors.forename: Kyung-Jo
authors.initials: KJ
authors.lastname: Kim
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Myung
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D002404:Catheterization / Q000295:instrumentation; D016099:Endoscopy, Gastrointestinal / Q000193:education* / Q000592:standards; D006801:Humans