Agreement Among Multiple Observers on Endoscopic Diagnosis of Esophageal Varices Before Bleeding

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Abstract
The interobserver variation in diagnosis and grading of esophageal varices may be ascribed by characteristics of the observers as well as to the patients. Assessment of this variation therefore requires the contributions of multiple observers and patients. Twenty–eight patients with cirrhosis without previous bleeding or known presence of varices were subjected to upper gastrointestinal endoscopy. Each endoscopy was videotaped and shown to 22 endoscopists. The varices were graded on a scale of 0 to 3 according to size. Each endoscopist diagnosed varices in 8 to 20 patients (mean = 15.9). Overall agreement on the presence (grades 1 to 3) or absence (grade 0) of varices was 70%. The average κ value was 0.38 (standard deviation = 0.16). Discrimination between varices graded 0 to 1 and varices graded 2 to 3 gave a higher κ value (p < 0.01) of 0.52 (standard deviation = 0.17). There was a large variation in κ values (range = -0.025 to 0.975). No significant correlation was observed between κ values for the two dichotomies (range = 0.16). The κ values were not related to the experience of the endoscopist. Considerable variation in the agreement on diagnosis and grading of esophageal varices was found. These results must be taken into account in the assessment of trials of prophylaxis of first–time variceal bleeding. (Hepatology 1990;11:341-347.)