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

© Georg Thieme Verlag KG Stuttgart · New York

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
Further Information

Publication History

submitted 22 February 2010

accepted after revision 11 June 2010

Publication Date:
30 August 2010 (online)

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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.

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K. Y. HoMD 

Yong Loo Lin School of Medicine
National University of Singapore

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