Title: Tu1146 Rs4898 Is a Genetic Variation Associated With the Susceptibility to Esophageal Achalasia
Abstract: 2013 and 11/2014, six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from 3 academic centers interpreted each of the 40 studies using both EPT and CLT formats, separated by at least 2 weeks.Inter-rater agreement was assessed by multirater Fleiss kappa (κ) statistic; κ values of 0.21-0.4,0.41-0.6,and 0.61-0.8were interpreted as fair, moderate, and substantial agreement, respectively.Diagnostic accuracy, defined by rater agreement with diagnoses designated by the consensus of two independent lead authors of each of the corresponding classification schemes (EPT: Bredenoord and Pandolfino.CLT: Spechler and Castell), was compared between the two display formats using conditional logistic regression.Accuracy was assessed both for correct diagnosis of esophageal motility diagnosis (exact diagnosis) and for identification of a major esophageal motility disorder.Results: The overall Fleiss κ statistic was 0.57 (95% CI 0.56-0.59)for EPT and 0.32 (0.30-0.33) for CLT.Inter-rater agreement between attendings and fellows was 0.68 (0.65-0.71) and 0.48 (0.45-0.50), respectively, for EPT and 0.46 (0.43-0.50) and 0.20 (0.17-0.24), respectively, for CLT.Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.1 times higher with CLT assessment than with EPT (OR 3.1; 95% CI 2.0-4.7;p<0.0001) and the odds of incorrect identification of a major motility disorder were 3.4 times higher with CLT than EPT (OR 3.43; p<0.0001).Accuracy results as assessed by position (attending/fellow) are displayed in Table 1.Pooled accuracy results are depicted in Figure 1.Conclusions: Superior inter-rater agreement and diagnostic accuracy of esophageal motility diagnoses was demonstrated with analysis using EPT over CLT in our selected group of raters.Esophageal pressure topography should be considered the primary assessment modality of esophageal motility.Diagnostic accuracy of esophageal motility disorders assessed by rater position.
Publication Year: 2015
Publication Date: 2015-04-01
Language: en
Type: article
Indexed In: ['crossref']
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