Variable reliability of endoscopic findings with white-light and narrow-band imaging for patients with suspected eosinophilic esophagitis

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 intraobserver reliability of endoscopic findings with white-light endoscopy and to assess changes in interobserver 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 intraobserver 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, interobserver agreement was fair to good when white light was used to identify rings (κ = 0.56) and furrows (κ = 0.48). Interobserver 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 intraobserver 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. Intraobserver agreement varied. Endoscopic findings might not be reliable for supporting a diagnosis of EoE or for making treatment decisions.