Background and aims: The American Foregut Society (AFS) recently developed an improved grading system of the esophagogastric junction (EGJ). In our study, we aimed to test the interobserver agreement of AFS EGJ classification system using real-time endoscopy. Methods: We conducted a prospective observational study at a single center from 10-2024 to 12-2024. Inclusion criteria were veterans ≥18 years old referred for upper endoscopy for evaluation of GERD. Exclusion criteria included history of foregut surgery, upper aerodigestive cancer or known major disorder of esophageal peristalsis. Baseline sociodemographic and clinical variables were collected. Five endoscopists completed standardized instruction on EGJ assessment before study initiation. Two endoscopists independently scored the EGJ of each patient. Endoscopists were blinded to one another and self-reported Gastroesophageal Reflux Disease Questionnaire (GERDQ) scores. Interobserver agreement among endoscopists was determined by using the kappa statistic with corresponding 95% confidence intervals (CIs) and strength of agreement was categorized according to established definitions for kappa values. Results: 117 patients met inclusion criteria and 70 successfully completed the study. The mean age was 53 and the participants were predominantly male (76%) and white (57%). Mean body mass index was 31 kg/m 2 with 35 (50%) reporting GERD symptoms ≥5 years. The AFS grade demonstrated fair overall interobserver agreement (κ = .371, P ≤ .001). AFS grade demonstrated a weak correlation with the GERDQ score (ρ = .077, P = .578). Conclusion: The AFS EGJ classification demonstrated fair interobserver agreement between endoscopists for patients referred for endoscopy for evaluation of GERD which has implications for widespread implementation.
lami et al. (Wed,) studied this question.
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