Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification

Kusano, Motoyasu; Ino, Kyoko; Yamada, Takuro; Kawamura, Osamu; Toki, Munetoshi; Ohwada, Tsuneo; Kikuchi, Kazuma; Shirota, Tohko; Kimura, Masayuki; Miyazaki, Makoto; Nakamura, Kazumi; Igarashi, Seigo; Tomizawa, Michiko; Tamura, Tatsuya; Sekiguchi, Toshio; Mori, Masataka

doi:10.1016/s0016-5107(99)70285-3

Cited by 62 publications

(51 citation statements)

References 6 publications

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“…Many studies of physician interobserver agreement demonstrate a wide range of deviation (6)(7)(8)(9). The main predictive factors for agreement were observer experience and type of findings.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5)(6)(7)(8)(9), as well as between gastroenterologists and nurses (10)(11)(12)(13). Most of the differences were associated with level of experience and borderline results (8,9).…”

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Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were preread by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved $324 per CE examination. The use of nurse practitioner to preread CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.KEY WORDS: M2A; capsule endoscopy; endoscopy; enteroscopy; small bowel.Recent studies recommending video capsule endoscopy (CE) as the method of choice for small bowel diagnostic endoscopy have led to its growing application in medical practice (1-4). At present, however, the extensive use of CE is limited by its high cost. Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5-9), as well as between gastroenterologists and nurses (10-13). Most of the differences were associated with level of experience and borderline results (8, 9). There was a high level of agreement for clear and well-known findings, such as polyps and ulcers, and a low level for indeterminate lesions such as irregular "Z-lines." Levinthal et al. (12) in a small study of 20 capsule videos, found that goal results were achieved when the capsule results were first read by a trained gastroenterology nurse who demarcated the areas of suspected pathology for further assessment by the physician. This strategy saved time and money without compromising the quality of the examination. It is supported by a wealth of evidence in the literature that gastroenterology nurses can efficiently interpret other types of endoscopic data (10-12).The aim of the...

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Section: Discussionmentioning

confidence: 99%

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Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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“…As diferentes classificações utilizadas para a graduação da ER apresentam algumas vantagens e desvantagens, pois os critérios de avaliação da agressão são controversos. Apesar da classificação de Los Angeles oferecer uma descrição melhor da lesão da mucosa, a variação intra-e interobservador que ocorre durante seu uso ainda é significativa, principalmente entre endoscopistas menos experientes 12 . Esses achados são equivalentes àqueles observados na utilização de classificação que considera alterações leves, como edema, hiperemia e friabilidade da mucosa, na definição de esofagite 13 .…”

Section: Discussionunclassified

Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy

Vieira¹,

Pisani²,

Mulinari³

2004

J Pediatr (Rio J)

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Objective: The aim of this study was to validate the endoscopic findings against histologic features of the distal esophageal mucosa for the diagnosis of reflux esophagitis in infants.Methods: The data records of 167 patients (88 M; 79F) aged 38-364 days, referred for investigation of reflux esophagitis, between January 1995 and December 2000 were retrospectively reviewed. The association between nominal (presence or absence of esophagitis) and ordinal (grades of esophagitis) variables was analyzed through a correlation between the results of endoscopic findings and histology.Results: Endoscopy when compared with histologic analysis had a sensitivity of 45%; specificity of 71%; positive and negative predictive value of 89% and 21% respectively; and accuracy of 50%. Additionally, this study demonstrated that there was a poor correlation between endoscopic and histologic findings when endoscopy was normal or when endoscopic grade I esophagitis was observed (p = 0.10). Normal esophageal appearance failed to identify 79.2% of patients with histologic esophagitis. Conversely, amongst patients with endoscopic grade I esophagitis, 12.1% had normal histology. Conclusions:We concluded that whilst endoscopy had a specificity of 71%, it did not attain an acceptable range of sensitivity (45%) to justify performing an endoscopy without biopsy, as many true cases of esophagitis would not be detected; and that the presence of grade I (non-erosive) esophagitis at endoscopy did not increase the value of the test in predicting histologic abnormality. ResumoObjetivo: O objetivo deste estudo foi o de validar os resultados do exame de endoscopia digestiva alta contra a histologia do esôfago distal para o diagnóstico da esofagite de refluxo em lactentes.Métodos: Foram revisados os prontuários de 167 pacientes (88 do sexo masculino e 79 do sexo feminino) com idade de 38 a 364 dias, encaminhados para investigação de esofagite de refluxo no período de janeiro de 1995 a dezembro de 2000. Analisou-se a associação entre as variáveis nominais (presença ou ausência de esofagite) e ordinais (graus de esofagite) através da comparação entre os resultados da endoscopia digestiva alta e histologia.Resultados: A endoscopia digestiva alta, quando comparada à histologia, apresentou sensibilidade de 45%, especificidade de 71%, valores preditivos positivo de 89% e negativo de 21%, e acurácia de 50%. Verificou-se baixa concordância entre os achados endoscópicos e histológicos na endoscopia digestiva alta normal ou na esofagite grau I (eritema leve ao nível da transição epitelial, apagamento, friabilidade e perda do brilho da mucosa) (p = 0,10). A endoscopia digestiva alta normal não identificou 79,2% dos pacientes com esofagite histológica. Entre os pacientes com esofagite grau I à endoscopia digestiva alta, 12,1% não apresentaram alterações histológicas.Conclusões: Concluiu-se que, enquanto a endoscopia digestiva alta apresentou especificidade de 71%, não atingiu sensibilidade aceitável (45%) para justificar sua realização sem biópsia; e que ...

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“…Statistical, DCT and DWT parameters have good overall efficiency in the range of 74% to 76% compared to HSI parameters. The kappa values vary between 0.683 to 0.6 LA Classification by presenting images and video to experts and trainee gastroenterologists has been reported in [17][18][19][20][21][22]. The kappa for intra-observer agreement was 0.54 and interobserver agreement was 0.22 reported by [17].…”

Section: Resultsmentioning

confidence: 99%

Los Angeles Classification of Esophagitis using Image Processing Techniques

Saraf¹,

Udupi²,

Hajare³

2012

IJCA

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Esophagitis is a condition of inflammation of the esophageal mucosa, which is also called as acid reflux disease. The cause maybe be due to slackness of the lower esophageal sphintcer which allows acidic contents of the food from stomach to esophagus. Esophagitis is detected by observing the esophagus by video endoscopy of the Upper Gastro-Intestinal tract. The classification of esophagitis is done by analyzing the images captured during the process of endoscopy. Classification of Esophagitis has many standards , with each standard having its plus and minus. The Los Angeles(LA) Classification deals with precise measurement of the mucosal breaks, for an image processing system to measure the mucosal breaks the position of the camera is to be known. We attempt to classify the Esophagitis using LA Classification without the camera position information using low level image features and classification is performed using a neural network classifier. The results of the classifier are compared with inter and intra observer variability studies. General Terms :Medical Diagnosis, Decision Support System

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Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification

Cited by 62 publications

References 6 publications

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy

Los Angeles Classification of Esophagitis using Image Processing Techniques

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