title: Interobserver Agreement on Endoscopic Classification of Oesophageal Varices in Children.
abstract: OBJECTIVE
  Data regarding agreement on endoscopic features of oesophageal varices in children with portal hypertension (PH) are scant. The aim of this study was to evaluate endoscopic visualisation and classification of oesophageal varices in children by several European clinicians, to build a rational basis for future multicentre trials.
  
  
  METHODS
  Endoscopic pictures of the distal oesophagus of 100 children with a clinical diagnosis of PH were distributed to 10 endoscopists. Observers were requested to classify variceal size according to a 3-degree scale (small, medium, and large, class A), a 2-degree scale (small and large, class B), and to recognise red wales (presence or absence, class Red). Overall agreement was considered fair if Fleiss and Cohen κ test was ≥0.30, good if ≥0.40, excellent if ≥0.60, and perfect if ≥0.80.
  
  
  RESULTS
  Agreement between observers was fair with class A (κ = 0.34) and class B (κ = 0.38), and good with class Red (κ = 0.49). The agreement was good on presence versus absence of varices (class A = 0.53, class B = 0.48). The agreement among the observers was good in class A when endoscopic features of severe PH (medium and large sizes, red marks) were grouped and compared with mild features (absent and small varices) (κ = 0.58).
  
  
  CONCLUSIONS
  Experts working in different centres show a fairly good agreement on endoscopic features of PH in children, although a better training of paediatric endoscopists may improve the agreement in grading severity of varices in this setting.
authors.affiliation: *Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo †Paediatric Surgery, Hospital Niguarda Ca' Granda, Milan ‡Paediatric Gastrointestinal Surgery and Endoscopy, Ospedale Pediatrico Bambino Gesù, Rome, Italy §Department of Paediatric Surgery, King's College Hospital, London ||Liver Unit, Birmingham Children's Hospital, Birmingham, UK ¶Gastroenterology Unit, Department of Paediatrics, University Hospitals, Geneva, Switzerland #Gastrointestinal Endoscopy, Hospital Papa Giovanni XXIII, Bergamo, Italy **Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University and School of Medicine ††Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital Necker-Enfants Malades, University of Paris-René Descartes, Paris, France ‡‡Paediatric Gastroenterology and Hepatology, University Hospital for Children and Adolescents, University of Tuebingen, Germany §§Gastroenterology Diagnostics Unit, Children's Health Memorial Institute, Warsaw, Poland ||||Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK. †Deceased.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: D'Antiga
authors.forename: Pietro
authors.initials: P
authors.lastname: Betalli
authors.forename: Paola
authors.initials: P
authors.lastname: De Angelis
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Giorgio
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McKiernan
authors.forename: Valerie
authors.initials: V
authors.lastname: McLin
authors.forename: Paolo
authors.initials: P
authors.lastname: Ravelli
authors.forename: Ozlem
authors.initials: O
authors.lastname: Durmaz
authors.forename: Cecile
authors.initials: C
authors.lastname: Talbotec
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Sturm
authors.forename: Marek
authors.initials: M
authors.lastname: Woynarowski
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000193:education / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000145:classification* / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000473:pathology; D008297:Male; D015588:Observer Variation; D010372:Pediatrics / Q000193:education / Q000706:statistics & numerical data; D015203:Reproducibility of Results