In this study, researchers from the United States evaluated intra- and inter-observer variability in the endoscopic scoring of esophagitis.
They assessed 2 grading schemes; the Los Angeles and Hetzel-Dent scales.
The team randomly displayed 325 endoscopic photographs of esophagitis, or healed esophagitis, to 9 endoscopist evaluators (4 experts, 5 trainees) by means of a CD-ROM.
Each photograph was shown twice.
The evaluators scored each photograph by using both classification schemes.
The research team used the kappa statistic as a measure of consistency.
|For experts, intra-observer reproducibility was greater using both Los Angeles and Hetzel-Dent classifications.|
The team found that for the trainees, intra-observer reproducibility was good (kappa = 0.436) when using the Los Angeles classification, but marginal ( kappa = 0.395) when using the Hetzel-Dent classification.
However, for the experts, intra-observer reproducibility was better when using both the Los Angeles (kappa = 0.545) and Hetzel-Dent classification (kappa = 0.552).
They also determined that inter-observer consistency for trainees was good when using both classifications (Los Angeles, kappa = 0.459; Hetzel-Dent, kappa = 0.427).
Again, for the expert evaluators, intra-observer reproducibility was better when using both classifications (Los Angeles, kappa = 0.556, Hetzel-Dent, kappa = 0.571).
When using the Los Angeles classification, only 5% and 8% of the photographs were interpreted to be more than 1 grade different from the mean for experts and trainees, respectively.
This same consistency was found by using the Hetzel-Dent classification scheme (experts 5%, trainees 10%).
Dr John Pandolfino's team concluded, "Reproducibility in grading esophagitis was good for both expert endoscopists and fellows, although there was greater consistency among the experts".
"Both the Los Angeles and Hetzel-Dent scoring systems are reproducible".
In a related editorial in the same publication, Dr Worth Boyce, from Florida, USA, discusses the need for an accurate endoscopic diagnosis of reflux esophagitis.
Dr Boyce states, that in order to achieve this, "A generally accepted classification or grading scheme that is easily understood and minimizes the degree of inter-observer disagreement is essential".