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Inter‐observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging
Author(s) -
Lee Sang Pyo,
Kae Sea Hyub,
Jang Hyun Joo,
Koh Dong Hee,
Jung Eun Suk
Publication year - 2021
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.13023
Subject(s) - medicine , reflux esophagitis , esophagitis , reflux , white light , endoscopy , radiology , gastroenterology , nuclear medicine , physics , disease , optics
Objectives Diagnosis of reflux esophagitis according to the Los Angeles classification minimal change (LA‐M) has a low inter‐observer agreement. We aimed to investigate whether the inter‐observer agreement of reflux esophagitis was better when expert endoscopists read the endoscopic images, or when the linked color imaging (LCI) or blue laser imaging (BLI)‐bright mode was used. In addition, whether the inclusion of LA‐M in the definition of reflux esophagitis affected the consistency of the diagnosis was investigated. Methods During upper endoscopy, endoscopic images of the gastroesophageal junction were taken using white light imaging (WLI), BLI‐bright, and LCI modes. Four expert endoscopists and four trainees reviewed the images to diagnose reflux esophagitis according to the modified LA classification. Results The kappa values for the inter‐observer variability for the diagnosis of reflux esophagitis were poor to fair among the experts (κ = 0.22, 0.17, and 0.27 for WLI, BLI‐bright, and LCI, respectively) and poor among the trainees (κ = 0.18, 0.08, and 0.14 for WLI, BLI‐bright, and LCI). The inter‐observer variabilities for the diagnosis of reflux esophagitis excluding LA‐M were fair to moderate (κ = 0.42, 0.35, and 0.42 for WLI, BLI‐bright, and LCI) among the expert endoscopists and moderate among the trainees (κ = 0.48, 0.43, and 0.51 for WLI, BLI‐bright, and LCI). Conclusions The inter‐observer agreement for the diagnosis of reflux esophagitis was very low for both the expert endoscopists and the trainees, even using BLI‐bright or LCI mode. However, when reflux esophagitis LA‐M was excluded from the diagnosis of esophagitis, the degree of inter‐observer agreement increased.