Abstract
The American Association for the Study of Liver Diseases recommends the use of a 2-grade classification system (small and large) to describe the size of oesophageal varices (OV). Data on observer agreement (OA) on this system are currently lacking. We aimed to evaluate this classification and compare it to the widely used 3-grade classification (grade 1 'small', grade 2 'medium', grade 3 'large') among operators of variable experience. High-definition video recordings of 100 patients with cirrhosis were prospectively collected using standardised criteria. Nine observers of variable experience performed independent evaluations of the videos in random order. OV were scored using both systems. All assessments were repeated a year later by the same observers to assess intra-observer agreement. Interobserver agreement (all observers) using the 2-grade and the 3-grade system was k=0.71 (95% CI: 0.64-0.78) and k=0.73 (95% CI: 0.66-0.79) respectively. When using the 2-grade system, intra-observer agreement between hepatologists (n=3), luminal gastroenterologists (n=3) and trainee gastroenterologists (n=3) was k=0.89 (95% CI: 0.86-0.91), k=0.72 (95% CI: 0.67-0.77), and k=0.74 (95% CI: 0.67-0.8) respectively. With the 3-grade system; intra-observer agreement between the same three subgroups were k=0.9 (95% CI: 0.87-0.92), k=0.73 (95% CI: 0.68-0.78), k=0.77 (95% CI: 0.71-0.82) respectively. There was no difference in OA between the 2-grade and 3-grade classification systems. Hepatologists had significantly higher levels of consistency in grading OV. This may have implications to create alternative training models for residents and fellows in the recognition and grading of OV.
Highlights
Oesophageal varices (OV) are a common finding in patients with liver disease
The Association for Study of Liver Disease (AASLD) recommends the use of a 2-grade classification system which has been previously validated as a predictor of variceal haemorrhage as opposed to the 3-grade system
Our study shows that there is no difference in both inter- and intra-observer agreement between the two systems among observers of variable experience
Summary
Oesophageal varices (OV) are a common finding in patients with liver disease. Guidelines recommend endoscopic surveillance of patients with known cirrhosis or portal hypertension.[4] Index endoscopic assessments are frequently performed by endoscopists with varying levels of experience in liver disease and portal hypertension. The American Association for the Study of Liver Diseases recommends the use of a 2-grade classification system (small and large) to describe the size of oesophageal varices (OV). When using the 2-grade system, intra-observer agreement between hepatologists (n = 3), luminal gastroenterologists (n = 3) and trainee gastroenterologists (n = 3) was k = 0.89 (95% CI: 0.86-0.91), k = 0.72 (95% CI: 0.67-0.77), and k = 0.74 (95% CI: 0.670.8) respectively. With the 3-grade system; intra-observer agreement between the same three subgroups were k = 0.9 (95% CI: 0.87-0.92), k = 0.73 (95% CI: 0.68-0.78), k = 0.77 (95% CI: 0.71-0.82) respectively.
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More From: Liver international : official journal of the International Association for the Study of the Liver
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