Goals: To assess a novel grading method of radiation proctitis for intraobser ver and interobserver agreement among endoscopists. Background: There are no est ablished criteria for the endoscopic classification of chronic radiation- induc ed proctopathy. We introduce a classification system based on telangiectasia den sity and vascular coalescence. Accuracy and reproducibility of this system were examined. Study: A total of 131 endoscopic images of the rectum in 74 consecutiv e patients undergoing lower endoscopy who had received pelvic radiation therapy were analyzed. Each image was duplicated, reversed, and rotated 90° for a tota l of 262 images. These were shown in random order to 13 endoscopist evaluators ( 6 attending physicians, 7 gastroenterology fellows) using an online computer tes ting program. Each image was scored from grade 0 to 3 using criteria from the rectal telangiectasia density (RTD) clas sification we developed. Kappa (κ ) statistics and percent agreement were used to quantify the reproducibility and level of agreement. Results: Intraobserver a greement: The mean (SD) for κ among the 13 raters was 0.58 (0.09); 95% confi dence interval [CI] = 0.527- 0.636. Interobserver agreement: The estimated κ across all 13 raters was 0.518 (95% CI = 0.506- 0.530). For the 7 trainees, κ was 0.547 (95% CI = 0.523- 0.571). For the 6 attending physicians, the κ was 0.481 (95% CI = 0.453- 0.509). As another indicator of agreement, all 1 3 evaluators agreed on 30 (22.9% ) of images, differed by no more than 1 grade on 60 (45.8% ) images, no more than 2 grades on 33 (25.2% ) of images, and no more than 3 grades on 8 of the images (6.1% ); 73% of patients referred for b leeding control were RTD grade 2 or 3. Conclusions: The RTD grding scale for rad iation proctopathy is reproducible among endoscopists. Hematochezia is associate d with high RTD grade.
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