Variable Reliability of Endoscopic Findings With White-Light and Narrow-Band Imaging for Patients With Suspected Eosinophilic Esophagitis

Abstract

Background & Aims Endoscopic findings have been used to support a diagnosis of eosinophilic esophagitis (EoE) and to assess response to therapy, but their reliability is unknown. The aim of the study was to assess inter- and intra-observer reliability of endoscopic findings with white-light endoscopy and to assess changes in inter-observer reliability when narrow band imaging (NBI) was added to white light. Methods We collected data from 35 academic and 42 community adult gastroenterologists using 2 self-administered, online assessments of endoscopic images in patients with suspected EoE. First, gastroenterologists evaluated 35-single white light images. Next, they examined 35-paired images of the initial white-light image and its NBI counterpart. To assess intra-observer reliability, a second survey, to re-examine the single white light images, was performed ≥2 weeks later. Agreement was determined by calculating κ values for multiple observers. Results Among all gastroenterologists, inter-observer agreement was fair to good when white light was used to identify rings (κ = 0.56) and furrows (κ = 0.48). Inter-observer agreement was poor for identification of plaques (κ = 0.29) and for images with no findings (κ = 0.34). Levels of agreement did not change in an analysis stratified by practice setting or patient volume. Agreement did not improve when NBI images were added to white light images. Levels of intra-observer agreement varied greatly and in some cases were not greater than those expected by chance. Conclusions Using white-light endoscopy and NBI to analyze EoE, gastroenterologists identified rings and furrows with fair to good reliability, but did not reliably identify plaques or normal images. Intra-observer agreement varied. Endoscopic findings might not be reliable for supporting a diagnosis of EoE or for making treatment decisions.

Endoscopic Classification of Esophagic Eosinophilia

“…This study shows that endoscopic findings alone are not enough to confirm the diagnosis of EsEo, since seventeen patients exhibited some endoscopic alteration, although histology demonstrated less than five EOS/HPF. This situation is similar to other published studies where authors state that endoscopic findings are not reliable to define the diagnosis and treatment [42,43].…”

546 Quantifying Human Eosinophils Using 3-Dimensional Volumetric Images Collected With Multi-Photon Fluorescence Microscopy

“…20 This result is consistent with the blue shift that has been observed in other studies, as well. 24 In order to address the focal and patchy nature of this disease, miniature two-photon imaging instruments [25][26][27] that are endoscope-compatible are being developed to collect MPM images in vivo. Conventional endoscopy alone has been found to be inadequate to support either diagnosis or treatment of EoE.…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…According to a meta-analysis conducted by Kim et al consisting primarily of retrospective studies involving adult cohorts, the overall pooled prevalence of endoscopic findings in patients with EoE was 44% rings, 21% strictures, 9% narrow caliber esophagus, 48% linear furrows, 27% white exudates, and 41% decreased vascularity, with a wide variation in the prevalence of those endoscopic findings between each report. This variation can be ascribed to a lack of an established diagnostic system via endoscopy in EoE, as indicated by the unsatisfactory interobserver agreement for the endoscopic findings [92]. On the other hand, when only the prospective studies were examined in the meta-analysis, 93% of patients were found to have at least one endoscopic abnormality.…”