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Abnormalities are commonly identified during endoscopy in eosinophilic esophagitis. There is no standardised classification to describe these features. Dr Ikuo Hirano and colleagues from Illinois, USA evaluated the interobserver agreement of a grading system for the esophageal features of esophageal esophagitis. The proposed system incorporated the grading of 4 major esophageal features, and the presence of additional features of narrow calibre esophagus, feline esophagus, stricture and crepe paper esophagus. Endoscopic videos from 25 patients with eosinophilic esophagitis, and controls were reviewed by 21 gastroenterologists.  | | Identification of narrow calibre esophagus had fair agreement | | Gut |
The researchers assessed interobserver agreement by estimating multi-rater κ and the proportion of pairwise agreement. Using the original grading system, the team noted that agreement for rings, furrows and exudates was moderate but poor for edema. Identification of narrow calibre esophagus had fair agreement while feline esophagus had poor agreement. After collapsing the severity grading for edema and furrows and eliminating poorly performing features of feline esophagus and narrow calibre esophagus, a modified grading system demonstrated good agreement for the 4 major features of eosinophilic esophagitis, and additional features of stricture and crepe paper esophagus. Dr Hirano's team commented, "The proposed system for endoscopically-identified esophageal features of eosinophilic esophagitis defines common nomenclature and severity scores for the assessment of eosinophilic esophagitis disease activity." "The system has good interobserver agreement among practising and academic gastroenterologists."
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