Interrater and intrarater agreement of the chicago classification of achalasia subtypes using high-resolution esophageal manometry

The American Journal of Gastroenterology
Jose C HernandezMichael D Crowell


Subclassification of achalasia based on high-resolution manometry (HRM) may be clinically relevant because response to therapy may vary by subtype. However, the consistency and reliability of subtyping achalasia patients based on HRM remains undefined. The objectives of this study were to assess interrater and intrarater agreement (reliability) of achalasia subtyping using the Chicago classification, and to evaluate the diagnostic consistency between clinicians interpreting HRM. After receiving training on the classification criteria, five raters classified 20 achalasia and 10 non-achalasia cases in separate sessions 1 week apart. To further assess agreement, two raters classified all 101 available achalasia HRMs. Agreement for the classification of subtypes of achalasia was calculated using Cohen's κ and Krippendorff's α-reliability estimate. Estimates of agreement among raters was good during both sessions (α=0.75; 95% confidence interval=0.69, 0.81 and α=0.75; 95% confidence interval=0.68, 0.81). Both interrater (κ=0.86-1.0) and intrarater (κ=0.86-1.0) agreement were very good for type III achalasia. Agreement between types I and II was more variable. Reliability was improved when type I and type II were combined (α=0.84; 95...Continue Reading


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