INTEROBSERVER AGREEMENT IN DEFECOGRAPHY - AN INTERNATIONAL STUDY

Background: Defecography is considered to be an essential investigatio n in the evaluation of functional anorectal disorders, but the agreeme nt between observers from different clinical centers has never been ev aluated. Methods: 14 defecographic studies were selected aimed to cove r the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were th ought to be controversial. All were sent: to the ten participants in E urope and the US (five proctosurgeons, three radiologists, two gastroe nterologists). They evaluated the studies using a previously agreed up on questionnaire. Interobserver agreement was quantified by kappa stat istics and by the proportions of positive and negative agreement as co mpared to chance agreement, respectively. Results: Overall, only the c ompleteness of rectal emptying and the presence of a rectocele achieve d acceptable kappa values above 0.4. When restricting the evaluation t o the studies considered to be unequivocal, agreement improved conside rably and was moderate to good for all items describing the images (ka ppa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa. Conclusions: It is doubtful whether defecography contributes substantially to the manage ment of patients with disordered defecation.