{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:00:00Z","timestamp":1792036800148,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,12,8]],"date-time":"2019-12-08T00:00:00Z","timestamp":1575763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>The American Association for the Study of Liver Diseases recommends the use of a 2\u2010grade classification system (small and large) to describe the size of oesophageal varices (OV). Data on observer agreement (OA) on this system are currently lacking. We aimed to evaluate this classification and compare it to the widely used 3\u2010grade classification (grade 1 \u2018small\u2019, grade 2 \u2018medium\u2019, grade 3 \u2018large\u2019) among operators of variable experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010definition video recordings of 100 patients with cirrhosis were prospectively collected using standardised criteria. Nine observers of variable experience performed independent evaluations of the videos in random order. OV were scored using both systems. All assessments were repeated a year later by the same observers to assess intra\u2010observer agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Interobserver agreement (all observers) using the 2\u2010grade and the 3\u2010grade system was <jats:italic>k<\/jats:italic>\u00a0=\u00a00.71 (95% CI: 0.64\u20100.78) and <jats:italic>k<\/jats:italic>\u00a0=\u00a00.73 (95% CI: 0.66\u20100.79) respectively. When using the 2\u2010grade system, intra\u2010observer agreement between hepatologists (n\u00a0=\u00a03), luminal gastroenterologists (n\u00a0=\u00a03) and trainee gastroenterologists (n\u00a0=\u00a03) was <jats:italic>k<\/jats:italic>\u00a0=\u00a00.89 (95% CI: 0.86\u20100.91), <jats:italic>k<\/jats:italic>\u00a0=\u00a00.72 (95% CI: 0.67\u20100.77), and <jats:italic>k<\/jats:italic>\u00a0=\u00a00.74 (95% CI: 0.67\u20100.8) respectively. With the 3\u2010grade system; intra\u2010observer agreement between the same three subgroups were <jats:italic>k<\/jats:italic>\u00a0=\u00a00.9 (95% CI: 0.87\u20100.92), <jats:italic>k<\/jats:italic>\u00a0=\u00a00.73 (95% CI: 0.68\u20100.78), <jats:italic>k<\/jats:italic>\u00a0=\u00a00.77 (95% CI: 0.71\u20100.82) respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was no difference in OA between the 2\u2010grade and 3\u2010grade classification systems. Hepatologists had significantly higher levels of consistency in grading OV. This may have implications to create alternative training models for residents and fellows in the recognition and grading of OV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14310","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T06:38:44Z","timestamp":1574663924000},"page":"905-912","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Validation of the AASLD recommendations for classification of oesophageal varices in clinical practice"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-7169","authenticated-orcid":false,"given":"Waleed","family":"Fateen","sequence":"first","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krish","family":"Ragunath","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"White","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amardeep","family":"Khanna","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Coletta","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Un V it Department of Pathophysiology and Transplantation Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Samuel","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobo","family":"Ortiz","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"James","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Wilkes","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3924-4830","authenticated-orcid":false,"given":"Guruprasad P.","family":"Aithal","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indra N.","family":"Guha","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and the University of Nottingham Nottingham UK"},{"name":"Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarmed S.","family":"Sami","sequence":"additional","affiliation":[{"name":"Department for Targeted Intervention Division of Surgery &amp; Interventional Science University College London (UCL) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2006.08.023"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.10.018"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000733"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28906"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02468653"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00299178"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21907"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198810133191505"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.20982\/tqmp.08.1.p023"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529786"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5466"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(90)91305-P"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(03)00404-5"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196107272650402"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196504222721604"},{"key":"e_1_2_9_17_1","first-page":"967","article-title":"Interobserver and intercenter agreement of gastro\u2010esophageal endoscopic signs in cirrhosis. Results of a prospective multicenter study","volume":"13","author":"Cal\u00e8s P","year":"1989","journal-title":"Gastroenterol Clin Biol"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840110302"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-966351"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000000822"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.07.021"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.022"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.06.021"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.750"},{"key":"e_1_2_9_25_1","volume-title":"Cochrane Database of Systematic Reviews","author":"Colli A","year":"2017"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14310","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.14310","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14310","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T01:24:32Z","timestamp":1694049872000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.14310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,8]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1111\/liv.14310"],"URL":"https:\/\/doi.org\/10.1111\/liv.14310","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,8]]},"assertion":[{"value":"2019-08-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}