Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system
Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system
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DOI：
10.1136/gutjnl-2011-301817
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发表时间：
2013-04-01
期刊：
影响因子：
24.5
通讯作者：
Achem, Sami R.
中科院分区：
文献类型：
--
作者：
Hirano, Ikuo;Moy, Nelson;Achem, Sami R.
目的 嗜酸性粒细胞性食管炎 (EoE) 内镜检查时常发现异常现象。没有标准化的分类来描述这些特征。本研究旨在评估 EoE 食管特征分级系统的观察者间一致性。 方法 该系统纳入了四种主要食管特征（环形、皱纹、渗出物、水肿）的分级以及窄口径食管、猫食管、狭窄和皱纹纸食管的附加特征。 21 名胃肠病学家审查了 25 名 EoE 患者和对照患者的内窥镜视频。通过估计多评估者 kappa 和成对一致性的比例来评估观察者间一致性。 结果 使用原始分级系统，环、皱纹和渗出物的一致性中等（kappa=0.38-0.46，56-65% 一致性），但水肿较差（kappa=0.23，51% 一致性）。细口径食管的识别具有良好的一致性（kappa = 0.30，74％一致性），而猫食管的一致性较差（kappa = 0.15，68％一致性）。在消除水肿和皱纹的严重程度分级并消除猫食管和窄口径食管的不良特征后，修改后的分级系统表现出与 EoE 的四个主要特征（kappa=0.40-0.54，71-81% 一致性）以及狭窄和皱纹纸食管的其他特征（kappa=0.52 和 0.58， 79% 和 92% 一致）。 结论 所提出的内窥镜识别 EoE 食管特征系统定义了评估 EoE 疾病活动性的通用术语和严重程度评分。该系统在执业和学术胃肠病学家之间具有良好的观察者间一致性。
Objective Abnormalities are commonly identified during endoscopy in eosinophilic oesophagitis (EoE). There is no standardised classification to describe these features. This study aimed to evaluate the interobserver agreement of a grading system for the oesophageal features of EoE.Method The proposed system incorporated the grading of four major oesophageal features (rings, furrows, exudates, oedema) and the presence of additional features of narrow calibre oesophagus, feline oesophagus, stricture and crepe paper oesophagus. Endoscopic videos from 25 patients with EoE and controls were reviewed by 21 gastroenterologists. Interobserver agreement was assessed by estimating multi-rater kappa and the proportion of pairwise agreement.Results Using the original grading system, agreement for rings, furrows and exudates was moderate (kappa=0.38-0.46, 56-65% agreement) but poor for oedema (kappa=0.23, 51% agreement). Identification of narrow calibre oesophagus had fair agreement (kappa=0.30, 74% agreement) while feline oesophagus had poor agreement (kappa=0.15, 68% agreement). After collapsing the severity grading for oedema and furrows and eliminating poorly performing features of feline oesophagus and narrow calibre oesophagus, a modified grading system demonstrated good agreement for the four major features of EoE (kappa=0.40-0.54, 71-81% agreement) and additional features of stricture and crepe paper oesophagus (kappa=0.52 and 0.58, 79% and 92% agreement).Conclusions The proposed system for endoscopically-identified oesophageal features of EoE defines common nomenclature and severity scores for the assessment of EoE disease activity. The system has good interobserver agreement among practising and academic gastroenterologists.