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Poor inter-observer agreement on the endoscopic diagnosis of eosinophilic esophagitis among Japanese endoscopists

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A variety of endoscopic findings are considered useful for the diagnosis of eosinophilic esophagitis (EoE). However, the diagnostic consistency among Japanese endoscopists for those findings has not been fully examined. The aim of this study was to investigate the inter- and intra-observer agreement for endoscopic findings suggesting EoE.


Forty endoscopists, including 20 with board certification from the Japan Gastroenterological Endoscopy Society (JGES), participated in this study. Initially, they examined 50 randomized white-light endoscopic images from 30 patients with EoE and 20 without EoE. Four weeks later, the same 50 endoscopic images were re-examined in a different random order. Inter- and intra-observer agreement was calculated using kappa statistics for multiple observers.


The kappa coefficient of reliability [95% confidence interval (CI)] for all 40 endoscopists for diagnosis of EoE was 0.34 (0.33–0.35), indicating poor level of inter-observer agreement, while intra-observer agreement showed a moderate value of 0.52 (0.47–0.57). Among 4 possible endoscopic findings (linear furrows, concentric rings, edema, white exudates) for EoE, acceptable levels (kappa value >0.4) of inter- and intra-observer agreement were seen only for linear furrows. When the JGES board-certified and non-certified endoscopists were compared for successful diagnosis of EoE, the value was significantly higher for the board-certified group. However, the level of inter-observer agreement remained poor level.


We concluded that inter-observer agreement on the endoscopic diagnosis of EoE among Japanese endoscopists did not reach a clinically acceptable level.

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This study was supported by the Health and Labour Sciences Research Grants for research on intractable diseases from the Ministry of Health, Labour and Welfare of Japan.

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Correspondence to Norihisa Ishimura.

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Ethical Statement

The present study was performed at the Shimane University Hospital in accordance with the Declaration of Helsinki and the protocol was approved by the ethics committee of the Shimane University School of Medicine. This study was registered with the University Hospital Medical Information Network (UMIN) clinical trials registry (UMIN 000018704).

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The authors declare no conflict of interests for this article.

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Izumi, D., Ishimura, N., Okada, M. et al. Poor inter-observer agreement on the endoscopic diagnosis of eosinophilic esophagitis among Japanese endoscopists. Esophagus 14, 309–316 (2017).

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