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Interobserver variability in antroduodenal manometry
F L Connor1, P E Hyman, C Faure
1Department of Gastroenterology, Hepatology and Nutrition, Royal Children's Hospital, Brisbane, Australia. flconnor@tpgi.com.au
Abstract:
Interobserver variability affects investigations involving assessment of complex visual data, such as histopathology, radiology and motility. This study assessed interobserver variation for interpretation of antroduodenal manometry (ADM), as this has not been previously investigated. Thirty-five ADM recordings from children aged 0.3-18 years were independently evaluated by five experienced paediatric gastroenterologists who were blinded to cases' clinical histories. Intra-class correlation (ICC) was analysed for detection and measurement of phase three of the migrating motor complex (MMC) and Cohen's kappa statistic was calculated between observer pairs for detection of specific motility features and final diagnosis. Observers were unanimous on the differentiation of normal and abnormal motility in 63% of cases. There was excellent interobserver agreement for the number of phase three of the MMC in fasting (ICC = 0.82, P < 0.0001) and for measurements of phase three of the MMC (ICC = 0.9999, P < 0.0001). Detection of other normal and abnormal motility patterns varied more. Objective findings such as the presence of phase three of the MMC correlated more closely than findings that involved the integration of several variables, such as final diagnosis. However, these data overall indicate that agreement between expert observers for the distinction of normal and abnormal antroduodenal motility compares favourably with other standard medical assessments.
Insights
Interobserver variability in interpreting antroduodenal manometry (ADM) was assessed. Expert agreement on normal versus abnormal motility was favorable, comparable to other medical assessments.
Area of Science:
- Gastroenterology
- Medical Diagnostics
- Physiology
Background:
- Interobserver variability is a known issue in interpreting complex visual data like histopathology and radiology.
- Interpretation of antroduodenal manometry (ADM) data, crucial for diagnosing motility disorders, has not been systematically evaluated for interobserver agreement.
Purpose of the Study:
- To assess the degree of interobserver variability among experienced pediatric gastroenterologists in interpreting antroduodenal manometry (ADM) recordings.
- To establish the reliability of ADM interpretation for differentiating normal from abnormal motility patterns in children.
Main Methods:
- Thirty-five ADM recordings from pediatric patients (0.3-18 years) were independently reviewed by five blinded pediatric gastroenterologists.
- Interobserver agreement was quantified using Intra-class correlation (ICC) for phase three of the migrating motor complex (MMC) detection and measurement.
- Cohen's kappa statistic was used to assess agreement on specific motility features and final diagnoses.
Main Results:
- Overall agreement on distinguishing normal from abnormal motility was achieved in 63% of cases.
- Excellent interobserver agreement was found for the detection (ICC = 0.82) and measurement (ICC = 0.9999) of phase three of the MMC.
- Agreement varied for other motility patterns and final diagnoses, with objective findings showing higher correlation than integrated assessments.
Conclusions:
- Interobserver agreement in ADM interpretation is comparable to other established medical diagnostic assessments.
- Objective ADM findings, like phase three of the MMC, demonstrate higher interobserver reliability than complex diagnostic integration.
- These findings support the utility of ADM in pediatric gastroenterology, while highlighting areas for potential standardization.
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