Evaluating the endoscopic reference score for eosinophilic esophagitis: moderate to substantial intra- and...

Area of Science:

• Gastroenterology
• Endoscopy
• Eosinophilic Esophagitis

Background:

• Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease.
• The Endoscopic Reference Score (EREFS) was recently developed for EoE assessment.
• Previous studies showed good interobserver agreement for most EREFS signs.

Purpose of the Study:

• To further validate the EREFS by assessing interobserver and intraobserver agreement.
• To evaluate the reliability of EREFS in diagnosing eosinophilic esophagitis.
• To compare agreement rates between expert and trainee endoscopists.

Main Methods:

• Endoscopic images from 30 eosinophilic esophagitis patients were evaluated.
• Four expert and four trainee endoscopists scored images, blinded to patient condition.
• Interobserver and intraobserver agreement were assessed using kappa statistics.

Main Results:

• Substantial agreement was found for rings, white exudates, and crepe paper esophagus.
• Moderate agreement was observed for furrows and strictures.
• Edema showed slight agreement, and agreement was not significantly different between experts and trainees.

Conclusions:

• The EREFS demonstrates consistent scoring of endoscopic signs in eosinophilic esophagitis.
• Both expert and trainee endoscopists achieved reliable agreement using the EREFS.
• The EREFS is a validated tool for consistent endoscopic assessment of EoE.