Elsevier

Gastrointestinal Endoscopy

Volume 56, Issue 5, November 2002, Pages 675-680
Gastrointestinal Endoscopy

Original Articles
Accuracy and reliability of the endoscopic classification of portal hypertensive gastropathy☆

https://doi.org/10.1016/S0016-5107(02)70116-8Get rights and content

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. (Gastrointest Endosc 2002;56:675-80.)

Section snippets

Materials and methods

Selected high-quality endoscopic digital images were retrieved from a computerized endoscopy archive that has been maintained since January 1991. These digital images were stored in Tagged Image File Format (TIFF) on an optical disk drive with commercially available software (ImageManager, Olympus America, Inc., Melville, N.Y.). Two investigators (H.Y.Y., P.J.T.) selected 98 images from patients with well-documented portal hypertension that reflected the spectrum of changes seen with PHG.

Results

Four of the 6 observers routinely used a 3-CCS in clinical practice, whereas 1 referred only to presence or absence of PHG with no attempt to quantitate the findings, and 1 described the observed findings in detail. The sensitivities of both classification systems for the diagnosis of PHG were similar and exceeded 98% (Table 2).

. Comparison of classification systems

Empty Cell2-CCS Mean3-CCS Meanp Value
Sensitivity98.2%98.1%0.434
Specificity54.9%51.0%0.939
% Agreement64.9%33.4%<0.0001
Within observer κ0.630.43

Discussion

A wide range of semiquantitative scoring systems is used in clinical practice to describe clinical findings with greater uniformity and to facilitate study of the natural history, complication rates, and prognostic implications of a given disease. When a scoring system is detailed, it represents the extent and severity of the condition in question with greater precision. However, the level of detail must be justifiable based on the ability of the scoring system to discriminate reliably among

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☆

Reprint requests: Paul J. Thuluvath, MD, FRCP, Division of Gastroenterology and Hepatology, Johns Hopkins University, Hospital, 1820 East Monument St., Room 428, Baltimore, MD 21205.

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Copyright © 2002 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.