PTU-091 Grading oesophageal varices in clinical practice: an inter-rater reliability study using high resolution endoscopy recordings

IntroductionVariceal size is a major predictor of the risk of bleeding in patients with liver cirrhosis. Guidelines from the American Association for the Study of the Liver (AASLD) recommend the use of a simplified system (small vs large) for grading of oesophageal varices (OV), but data on the reliability of this system compared to the conventional 3- grade classification remains lacking. We aimed to assess inter-rater reliability of these two widely used grading systems for OV.MethodHigh-resolution endoscopy recordings of 108 patients (n=8 training cohort and n=100 evaluation cohort) with chronic liver disease were prospectively collected using standardised criteria. Nine Gastroenterologists of variable experience performed independent evaluations of the videos in a random order. The cases were scored according to the presence or absence of OV. If OV were present they were scored using a 2-grade system (small and large) as well as a 3-grade system (small, medium and large). Overall agreement was analysed using intraclass correlation coefficient or kappa statistic as required.ResultsAgreement on the presence or absence of varices was good (k=0.6, p