Accuracy of Novice Raters for Esophageal Motility Classifications Using Functional Lumen Imaging Probe Panometry

Functional lumen imaging probe (FLIP) Panometry classifies esophageal motility using esophagogastric junction (EGJ) opening and esophageal contractile patterns. A previous study evaluated FLIP Panometry interpretation among esophageal specialists (which demonstrated an average accuracy of 78% for FLIP motility diagnoses), but the interpretation performance of nonexperts remains unknown. This study aimed to assess the accuracy and interrater agreement of novice raters using FLIP Panometry v1.0 and the novel v2.0 (Dallas Consensus) motility classification schemes.

Eight non-gastroenterology trainees without previous FLIP or esophageal motility experience interpreted 40 FLIP studies. Brief training included a video tutorial and review of 10 practice studies with an esophageal specialist. Accuracy was assessed using percent agreement with the reference standard assigned by two experienced raters. Interrater agreement was assessed using intraclass correlation coefficient (ICC) and Fleiss' kappa.

Accuracy of motility diagnosis was mean (95% CI) 0.73 (0.68-0.78) for v2.0 and 0.78 (0.73-0.82) for v1.0. Accuracies ≥ 78% were achieved by four raters for v2.0 and five for v1.0, while other raters' accuracies ranged from 55% to 75%. Accuracy for EGJ opening classification was 0.80 (0.75-0.84) and for contractile response pattern was 0.78 (0.74-0.83) for v2.0 and 0.78 (0.74-0.83) for v1.0. Moderate-to-good interrater agreement was observed (ICC 0.80-0.83; kappa 0.55-0.61).

Following brief training, some novice raters achieved accuracy akin to esophageal motility specialists when interpreting FLIP Panometry motility studies. While variation in accuracy highlights the need for improved and adequate training methods for esophageal motility interpretation, accurate FLIP Panometry interpretation was achievable among nonspecialists, supporting feasibility for broad use.