Korean J Gastrointest Endosc > Volume 33(4); 2006 > Article
Korean Journal of Gastrointestinal Endoscopy 2006;33(4): 197-203.
위식도 역류질환의 내시경 진단에서 관찰자 간 차이
성균관대학교 의과대학 내과학교실, *고려대학교 의과대학 내과학교실, 가톨릭대학교 의과대학 내과학교실, 연세대학교 의과대학 의학통계학교실, §내과학교실
Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease
Jun Haeng Lee, M.D., Jong-Soo Lee, M.D., Poong-Lyul Rhee, M.D., Hoon Jai Chun, M.D.*, Myung-Gyu Choi, M.D., Young-Tae Bak, M.D.*, Dongkee Kim, M.D., Kijun Song, M.D. and Sang In Lee, M.D.§
Department of Medicine, Sungkyunkwan University School of Medicine, Suwon, *Department of Internal Medicine, Korea University College of Medicine, Seoul, Department of Medicine, The Catholic University of Korea College of Medicine, Seoul, Departments of Biostatistics, §Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients.
The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value.
The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402.
Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups. (Korean J Gastrointest Endosc 2006;33:197⁣203)
Key Words: Gastroesophageal reflux disease, LA classification, Minimal change
주요어: 위식도 역류질환, LA 분류, 미세변화
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