The endoscopic landmark used to diagnose Barrett's esophagus differs between Japanese and Western endoscopists.
Dr Yuji Amano and colleagues from Japan compared the degree of diagnostic variation in results achieved by Japanese endoscopists
The palisade vessels were used as a landmark of the distal esophagus.
The research team evaluated the gastric folds, interobserver diagnostic concordance.
Projected endoscopic photographs were viewed by 84 endoscopists to classify 30 patients with Barrett's esophagus.
The endoscopists were asked to identify the distal end of the esophagus, first by using the Japanese criteria and later by using the gastric folds after an explanation of the Prague C&M Criteria.
|Using the C&M Criteria, there was an improvement in the diagnostic concordance|
Endoscopists were divided into groups according to years in practice as an endoscopist, presence or absence of board certification from the Japan Gastroenterological Endoscopy Society.
The researchers further divided endoscopists into groups according to whether they had taken any special endoscopic training courses on gastroesophageal reflux disease.
The kappa coefficient of reliability was calculated for each group.
The initial overall kappa value for all the endoscopists for the identification of the distal end of the esophagus was only 0.14.
The team report that this is an unacceptably low value of concordance over and above chance agreement.
The team found that length of experience with diagnostic endoscopy, board license, or special training had no impact on the level of concordance.
After an explanation of the C&M Criteria, however, the researchers observed a significant improvement in the diagnostic concordance.
Dr Amano's team concludes, “The upper end of the gastric folds, as used in C&M Criteria, may be a more suitable landmark than the palisade vessels for identifying the distal end of the esophagus by endoscopy.”