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

Abstract

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.

The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

“… 6 Since LCI enhances color contrast, it facilitates the identification of these typical endoscopic findings. 14 , 15 , 54 Moreover, under LCI, H. pylori -infected mucosa appeared deep red (crimson) in color, while H. pylori -negative mucosa (past infection or uninfected patients) could clearly be observed as apricot in color, which could be detected better because of distinctive color differences. 11 , 13 , 41 Dohi et al 11 showed that LCI improved the endoscopic diagnosis of active H. pylori infections, with 10% to 15% improvements in accuracy, sensitivity, and specificity over WLI.…”

Role of linked color imaging for upper gastrointestinal disease: present and future

“…However, a recent Korean study showed that the interobserver agreement for the diagnosis of reflux esophagitis was very low for both experts and trainees, even after using BLI-brt or LCI. 17 This interobserver discrepancy was particularly prominent in grade LA-M reflux esophagitis. Therefore, further research is required to determine whether LCI is useful for the diagnosis of gastroesophageal reflux disease.…”

Role of endoscopy in gastroesophageal reflux disease

“…BLI utilizes two monochromatic lasers (410 and 450 nm) to improve the visualization of the vascular microarchitecture of the mucosal surface. 27 This newer technology overcomes the limitation of a dark field view in previous narrowed-spectrum technologies. In contrast, LCI uses a specific color-enhancing technology that distinguishes color in red regions of mucosal blood vessels to improve the identification of red and discolored lesions based on differences in mucosal color.…”