P0646 - American Foregut Society Classification of Gastroesophageal Junction Integrity Correlates With Severity of GERD and Shows Good Interobserver and Intraobserver Agreement
Sabu K. Gopi, MBBS, MD, DM, Vijosh V. Kumar, MBBS, MD, Vivek Kumar, MBBS, MD, DM, Javed P, MBBS, MD, DM, Jaseen Ansari, MBBS, MD, DM, Kavitha Rangan, MBBS, MD, DM ASTER MIMS HOSPITAL KANNUR, Kannur, Kerala, India Introduction: Gastroesophageal reflux disease (GERD) is a common condition characterised by reflux of gastric contents into esophagus. The assessment of gastroesophageal junction integrity plays critical role in evaluation and management of GERD. The American Foregut Society (AFS) classification has emerged as a valuable tool in assessing the integrity of gastroesophageal junction with more accuracy. The study aimed to assess the ability of AFS classification to predict the severity of GERD and to evaluate interobserver and intra observer agreement Methods: We performed a prospective study of patients with GERD symptoms who underwent upper GI endoscopy. All patients were surveyed before endoscopy with GERD-HRQL questionnaire. Endoscopy was used to evaluate AFS grade. Four endoscopists blindly and independently assessed endoscopy videos twice, one month apart. The correlation between GERD scores and AFS grades was analysed using Spearman’s test. The Quadratic Weighted Kappa (QWK) statistic was used to evaluate the inter and intraobserver agreement, accounting for the ordinal nature of the classifications.We performed a prospective study of patients with GERD symptoms who underwent upper GI endoscopy. All patients were surveyed before endoscopy with GERD-HRQL questionnaire. Endoscopy was used to evaluate AFS grade. Four endoscopists blindly and independently assessed endoscopy videos twice, one month apart. The correlation between GERD scores and AFS grades was analysed using Spearman’s test. The Quadratic Weighted Kappa (QWK) statistic was used to evaluate the inter and intraobserver agreement, accounting for the ordinal nature of the classifications. Results: A total of 458 patients were included in the study. The study population had a mean age of 45.17 years, with 40.8% females and 59.2% males. There was a strong correlation between AFS grades and GERD-HRQL(r=0.884). The Quadratic Weighted Kappa analysis revealed average inter-rater agreement of 0.71. The average intra-rater agreement was 0.74. AFS grading demonstrated slightly better intra-rater reliability. Agreement between AFS grading and observer grades was substantial to excellent (Quadratic Kappa: 0.745 to 0.969). Discussion: AFS classification of gastroesophageal junction integrity shows strong correlation with severity of GERD. This endoscopy-based classification demonstrated strong inter-observer and intra-observer agreement. This improved agreement augments the reliability of AFS classification to assess esophagogastric junction integrity
Disclosures: Sabu K. Gopi indicated no relevant financial relationships. Vijosh V. Kumar indicated no relevant financial relationships. Vivek Kumar indicated no relevant financial relationships. Javed P indicated no relevant financial relationships. Jaseen Ansari indicated no relevant financial relationships. Kavitha Rangan indicated no relevant financial relationships.
Sabu K. Gopi, MBBS, MD, DM, Vijosh V. Kumar, MBBS, MD, Vivek Kumar, MBBS, MD, DM, Javed P, MBBS, MD, DM, Jaseen Ansari, MBBS, MD, DM, Kavitha Rangan, MBBS, MD, DM. P0646 - American Foregut Society Classification of Gastroesophageal Junction Integrity Correlates With Severity of GERD and Shows Good Interobserver and Intraobserver Agreement, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
