COMMENTARY

The Diagnosis of EoE: More Questions Than Answers

David A. Johnson, MD

Disclosures

July 21, 2011

In This Article

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

Peery AF, Cao H, Dominik R, Shaheen NJ, Dellon ES
Clin Gastroenterol Hepatol.2011;9:475-480

Study Summary

This prospective study gathered data from 35 academic and 42 community gastroenterologists who completed 2 self-administered Web-based online assessments of endoscopic images of "suspected EoE." The first was a white light image, and then the white light image was paired with a corresponding narrowband image (NBI). Interobserver agreement was fair to good for rings (kappa = 0.56) and furrows (kappa = 0.48) but poor for plaques (kappa = 0.29) and no findings (kappa = 0.34). Type of practice, patient volume, and use of NBI did not influence the levels of agreement. A re-evaluation was performed by 46% of the participants 2 weeks after the initial assessment, finding a wide variation in intraobserver agreement. Kappa values for esophageal rings ranged from 0.2 to 0.9, whereas for no findings the kappa values ranged from 0.0 to 1.0.

Viewpoint

Although the endoscopic features of EoE are not requisite for the diagnosis, they are hallmarks to support and follow a response to treatment. The findings of this study are surprising because they suggest that not only are the inter- and intraobserver reliabilities fair at best, but they are also subject to considerable variability. Furthermore, advanced imaging with NBI did not improve the variances in detection, and to some degree actually reduced recognition of features of EoE. Overall, the results of this study suggest that endoscopic findings in patients with suspected EoE may not be reliable enough to establish the diagnosis and base treatment decisions.

Abstract

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