Interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus: an Asian multinational study

Y. C. Lee; M. B. Cook; S. Bhatia; W. H. Chow; E. M. El-Omar; H. Goto; J. T. Lin; Y. Q. Li; P. L. Rhee; P. Sharma; J. J. Y. Sung; J. Y. Y. Wong; J. C. Y. Wu; K. Y. Ho

doi:10.1055/s-0030-1255629

Endoscopy 2010; 42(9): 699-704
DOI: 10.1055/s-0030-1255629

Original article

Interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus: an Asian multinational study

Y. C. Lee¹ ^, ² , M. B. Cook³ , S. Bhatia⁴ , W. H. Chow³ , E. M. El-Omar⁵ , H. Goto⁶ , J. T. Lin¹ ^, ⁷ , Y. Q. Li⁸ , P. L. Rhee⁹ , P. Sharma¹⁰ , J. J. Y. Sung¹¹ , J. Y. Y. Wong¹² , J. C. Y. Wu¹¹ , K. Y. Ho¹² , and the Asian Barrett’s Consortium

¹Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
²Division of Biostatistics, College of Public Health, National Taiwan University, Taipei, Taiwan
³Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
⁴Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
⁵Division of Applied Medicine, Institute of Medical Sciences, Aberdeen University, Aberdeen, Scotland
⁶Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
⁷Department of Internal Medicine, E-DA Hospital and I-Shou University, Yan-chau Shiang, Kaohsiung County, Taiwan
⁸Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
⁹Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
¹⁰Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA
¹¹Department of Medicine & Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong
¹²Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Abstract

Background and study aim: The establishment of precise and valid diagnostic criteria is important for any disease. We determined the interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus.

Patients and methods: Video clips of endoscopy in 21 patients with/without Barrett’s esophagus were used for training (n = 3) and for diagnosis/grading (n = 18) of Barrett’s esophagus by endoscopists from seven hospitals in Asia. Barrett’s esophagus was graded using the Prague C & M Criteria whereby the circumferential extent of the Barrett’s segment (C value), maximum extent of Barrett’s segment (M value), location of the gastroesophageal junction, and location of the diaphragmatic hiatus were scored. The intraclass correlation coefficients (ICC) were calculated as a measure of interobserver reliability.

Results: A total of 34 endoscopists participated. ICC values for the scores of the C value, M value, location of the gastroesophageal junction, and location of the diaphragmatic hiatus were: 0.92 (95 % confidence interval [CI] 0.88 – 0.97), 0.94 (95 %CI 0.90 – 0.98), 0.86 (95 %CI 0.78 – 0.94), and 0.81 (95 %CI 0.71 – 0.92), respectively, indicating excellent interobserver agreement. The differences in region/country, endoscopists’ experience, case volume of participating centers, or primary practice type had no significant effect on the reliability. The ICC values for recognition of Barrett’s esophagus of ≥ 1 cm were 0.90 (95 %CI 0.80 – 1.00) and 0.92 (95 %CI 0.87 – 0.98) for the C and M values, respectively, whereas the corresponding ICC values for Barrett’s segment of < 1 cm were 0.18 (95 %CI 0.03 – 0.32) and 0.21 (95 %CI 0.00 – 0.51), respectively.

Conclusions: Despite the uncommon occurrence of Barrett’s esophagus in Asia, our endoscopists exhibited excellent agreement in the endoscopic diagnosis and grading of Barrett’s esophagus using the Prague C & M Criteria. However, in view of the low interobserver reliability in recognizing Barrett’s segments of < 1 cm, future studies in Asia should take this into account when selecting the study population.

Full Text

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K. Y. HoMD

Yong Loo Lin School of Medicine
National University of Singapore

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Email: khek_yu_ho@nuhs.edu.sg