S879 American Foregut Society Classification of Gastroesophageal Junction Integrity Correlates With Severity of GERD and Shows Good Interobserver and Intraobserver Agreement

Introduction: Gastroesophageal reflux disease (GERD) is a common condition characterized by reflux of gastric contents into the esophagus. The assessment of gastroesophageal junction integrity plays a 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 the 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 intraobserver 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 Health-Related Quality of Life (GERD-HRQL) questionnaire. Endoscopy was used to evaluate AFS grade. Four endoscopists blindly and independently assessed endoscopy videos twice, 1 month apart. The correlation between GERD scores and AFS grades was analyzed 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% women and 59.2% men. There was a strong correlation between AFS grades and GERD-HRQL (r = 0.884). The QWK 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). Conclusion: AFS classification of gastroesophageal junction integrity shows strong correlation with severity of GERD. This endoscopy-based classification demonstrated strong interobserver and intraobserver agreement. This improved agreement augments the reliability of AFS classification to assess esophagogastric junction integrity.