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Feasibility of a simplified narrow-band imaging classification system for Barrett’s esophagus for novice endoscopists

  • Original Article—Alimentary Tract
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Abstract

Background

Narrow-band imaging (NBI) classifications for Barrett’s esophagus have been proposed for the detection of early esophageal adenocarcinoma. We developed a simplified classification system with demonstrated high diagnostic accuracy and reproducibility among experienced endoscopists, but the feasibility of this system among novice endoscopists was unclear.

Methods

In the present study, eight novice endoscopists with no experience of magnification endoscopy were asked to review 248 images of Barrett’s esophagus (72 dysplastic, 176 non-dysplastic) obtained using high-definition magnification endoscopy with NBI 6 weeks before (1st test), immediately after (2nd test), and 6 weeks after (3rd test) being taught the simplified classification system. The primary outcomes were differences in diagnostic accuracy for dysplasia among the three tests.

Results

The specificity and overall accuracy improved significantly in the 2nd vs. 1st test [97% vs. 80% (p < 0.001) and 94% vs. 82% (p < 0.001), respectively], but sensitivity was comparable (87% in both tests; p = 0.42). In the 3rd test, the sensitivity and overall accuracy decreased significantly compared with the 2nd test [82% vs. 87% (p < 0.001) and 93% vs. 94% (p < 0.05), respectively], but there was no significant difference in specificity (97% in both tests; p = 0.16). The kappa values for interobserver agreement for the mucosal pattern, vascular pattern, and predicted histology were substantial, and improved significantly in the 2nd vs. 1st test (0.78 vs. 0.59, 0.70 vs. 0.53, and 0.79 vs. 0.66, respectively; p < 0.001 for all).

Conclusions

The simplified NBI classification system may be appropriate for novice endoscopists to use in providing high accuracy and reproducibility.

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Acknowledgements

The authors thank Professor Hisao Tajiri for the management and composition of this study and Dr. Shinichi Hirooka for advice on histopathological findings.

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Authors and Affiliations

  1. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Hiroto Furuhashi, Akira Dobashi & Hiroaki Matsui

  2. Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan

    Kenichi Goda

  3. Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan

    Yuichi Shimizu

  4. Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo, Japan

    Masayuki Kato

  5. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Masakazu Takahashi, Koji Hirata, Ayane Oba, Taku Shigesawa & Masaki Inoue

  6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Chika Kinoshita & Yoshitaka Ando

  7. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan

    Masahiro Ikegami

  8. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Tadakazu Shimoda

  9. National Hospital Organization Hakodate Hospital, Hakodate, Japan

    Mototsugu Kato

Authors
  1. Hiroto Furuhashi
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  2. Kenichi Goda
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  3. Yuichi Shimizu
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  11. Hiroaki Matsui
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  14. Masahiro Ikegami
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  15. Tadakazu Shimoda
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  16. Mototsugu Kato
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Corresponding author

Correspondence to Kenichi Goda.

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Conflict of interest

Akira Dobashi holds a patent on application No. US-62628024.

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Furuhashi, H., Goda, K., Shimizu, Y. et al. Feasibility of a simplified narrow-band imaging classification system for Barrett’s esophagus for novice endoscopists. J Gastroenterol 54, 587–596 (2019). https://doi.org/10.1007/s00535-018-01537-7

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  • DOI: https://doi.org/10.1007/s00535-018-01537-7

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