Adverse events in gastrointestinal endoscopy: Validation of the AGREE classification in a real-life 5-year setting

The novel AGREE classification for adverse events (AEs) in gastrointestinal (GI) endoscopy has not yet been validated in a real-world setting.

Our study aims to evaluate the correlation between the grades of AEs in the ASGE and AGREE classifications and to assess the interobserver agreement of the two classification systems.

The correlation and association between the AE grades of the ASGE and AGREE classifications were analyzed using the Spearman rank correlation test and the chi-squared analysis, respectively. A weighted Cohen's kappa coefficient analysis was performed to determine the interobserver agreement of both classification systems.

We prospectively collected the AEs that occurred in our endoscopy unit over the past five years. A total of 226 AEs (226/84,863, 0.3%) occurred. There was a correlation between the ASGE and AGREE classifications (ρ = 0.61) and a moderately significant association (p < 0.01, Cramer's V = 0.7). The interobserver agreement for the ASGE classification was fair (kappa 0.60, 95% confidence interval [CI]: 0.54, 0.67), whereas it was good for the AGREE classification (kappa 0.80, 95% CI: 0.62, 0.87).

The AGREE classification was validated for the first time in a real-world setting and showed a positive correlation and higher interobserver agreement than the ASGE classification.