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Interobserver agreement on endoscopic diagnosis of low-grade reflux esophagitis, including minimal changes

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Abstract

Background

In Japan, the majority of patients with gastroesophageal reflux disease have low-grade reflux esophagitis (RE), including minimal changes, and the modified Los Angeles (LA) classification is widely used. However, there have been few evaluations of interobserver agreement with this classification. This study was performed to elucidate the level of interobserver agreement for diagnosis low-grade RE, including minimal changes, and to identify any clinical factors that influenced the results.

Methods

A total of 114 endoscopists from university hospitals, community hospitals, and private practice participated. They assessed the grade of esophagitis in 8 patients by viewing endoscopic images. The images were projected onto a screen, and all of the endoscopists reviewed images together. The diagnosis was selected from the following five categories: grade M, grade A, short-segment columnar-lined esophagus, diagnosis difficult due to poor image quality, and others. After discussiing the endoscopic diagnosis, the images were projected in a random order and the endoscopists viewed them again. Kappa coefficients of reliability were calculated before and after the discussion, and we also evaluated factors influencing the results.

Results

The kappa values obtained before and after discussion were 0.41 and 0.70, respectively. We found three factors that influenced interobserver agreement: specialty, years of experience with endoscopic examination, and mean esophageal observation time per endoscopic examination.

Conclusions

The modified LA classification is reliable for diagnosing low-grade RE (including minimal changes) in Japan, although several factors can influence interobserver agreement.

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Abbreviations

CI:

Confidence interval

GERD:

Gastroesophageal reflux disease

JGES:

Japan Gastroenterological Endoscopy Society

LA classification:

The Los Angeles classification

LSBE:

Long-segment Barrett’s esophagus

NERD:

Non-erosive reflux disease

SSBE:

Short-segment Barrett’s esophagus

SS-CLE:

Short-segment columnar-lined esophagus

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Acknowledgments

The Committee for Assessment of Endoscopic Finding of GERD comprises the following investigators: Junichi Akiyama from International Medical Center of Japan, Tokyo, Japan; Yuji Amano from Division of Endoscopy, Shimane University Hospital, Izumo-shi, Japan; Shuichi Ohara from Tohoku Rosai Hospital, Sendai, Japan; Mitsuru Kaise from Toranomon Hospital, Tokyo, Japan; Mototsugu Kato and Katsuhiro Mabe from Hokkaido University Hospital, Sapporo, Japan; Tetsuyuki Kawano from Tokyo Medical and Dental University, Tokyo, Japan; Motoyasu Kusano from Gunma University Hospital, Maebashi, Japan; Kaiyo Takubo from Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Hideki Toyota from Happy GI Clinic, Kameyamashi-honmachi, Japan; Kiyoshi Ashida from Saiseikai Nakatsu Hospital, Osaka, Japan; Hiroto Miwa from Hyogo College of Medicine, Nishinomiya, Japan; Kazuyoshi Yagi from Niigata Prefectural Yoshida Hospital, Yoshida-machi, Japan; Haruhiro Yamashita from Okayama Medical Center, Okayama, Japan.

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-1092, Japan

    Noriaki Manabe

  2. Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan

    Ken Haruma

  3. Clinic of the Ministry of Economy, Trade and Industry, Tokyo, Japan

    Yoshio Hoshihara

  4. Department of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, Izumo, Japan

    Yoshikazu Kinoshita

  5. Department of Comprehensive Medicine, Tohoku University Hospital, Sendai, Japan

    Michio Hongo

  6. Tokai University Hachioji Hospital General Surgery, Tokyo, Japan

    Hiroyasu Makuuchi

Authors
  1. Noriaki Manabe
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  2. Ken Haruma
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  3. Yoshio Hoshihara
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  4. Yoshikazu Kinoshita
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  6. Hiroyasu Makuuchi
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Correspondence to Noriaki Manabe.

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Manabe, N., Haruma, K., Hoshihara, Y. et al. Interobserver agreement on endoscopic diagnosis of low-grade reflux esophagitis, including minimal changes. Esophagus 9, 9–16 (2012). https://doi.org/10.1007/s10388-011-0307-3

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