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Diagnostic validity and learning curve of non-NBI expert endoscopists in gastric intestinal metaplasia diagnosis

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Abstract

Background

Endoscopists’ experience influences narrow-band imaging (NBI)-guided gastric intestinal metaplasia (GIM) diagnostic performance. We aimed to evaluate the general gastroenterologists (GE) performance in NBI-guided GIM diagnosis compared to NBI experts (XP) and assess GEs’ learning curve.

Methods

A cross-sectional study was conducted between 10/2019 and 2/2022. Histology-proven GIM who underwent esophagogastroduodenoscopy (EGD) were randomly assessed by 2XPs or 3GEs. Endoscopists’ performance on NBI-guided diagnoses were compared to the pathological diagnosis (gold standard) in five areas of the stomach according to the Sydney protocol. The primary outcome were GIM diagnosis validity scores of GEs compared to XPs. The secondary outcome was the minimum number of lesions required for GEs to achieve an accuracy of GIM diagnosis ≥ 80%.

Results

One thousand one hundred and fifty-five lesions from 189 patients (51.3% male, mean age 66 ± 10 years) were examined. GEs performed EGD in 128 patients with 690 lesions. the GIM diagnosis sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GEs compared to the XPs, were 91% vs.93%, 73% vs.83%, 79% vs.83%, 89% vs.93%, and 83% vs.88%, respectively. GEs demonstrated lower specificity (mean difference − 9.4%; 95%CI − 16.3, 1.4; p = 0.008) and accuracy (mean difference − 5.1%; 95%CI − 3.3, 6.3; p = 0.006) compared to XPs. After 100 lesions (50% GIM), GEs achieved an accuracy of ≥ 80% and all diagnostic validity scores were comparable to the XPs (p < 0.05 all).

Conclusions

Compared to XPs, GEs had lower specificity and accuracy for GIM diagnosis. The learning curve for a GE to achieve comparable performance to XPs would necessitate at least 50 GIM lesions.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand

    Kasenee Tiankanon, Rapat Pittayanon, Natee Faknak, Jarongkorn Sirimongkolkasem, Pakkapon Rattanachaisit & Rungsun Rerknimitr

  2. Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

    Nathawadee Lerttanatum, Anapat Sanpavat & Naruemon Klaikaew

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  1. Kasenee Tiankanon
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Contributions

Conception and design: RP. Data collection: KT, NF, RP, JS, PR, NL, AS, NK. Analysis and interpretation of the data: KT, NF, RP. Drafting of the article: KT, RP. Critical revision of the article for important intellectual content: KT, RP, RR. Final approval of the article: All of the authors.

Corresponding author

Correspondence to Rapat Pittayanon.

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Disclosure

Dr. Kasenee Tiankanon, Dr. Rapat Pittayanon, Dr. Natee Faknak, Dr. Jarongkorn Sirimongkolkasem, Dr. Pakkapon Rattanachaisit, Dr. Nathawadee Lerttanatum, Dr. Anapat Sanpavat, Dr. Naruemon Klaikaew, and Dr. Rungsun Rerknimitr have no conflicts of interest or financial ties to disclose.

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Tiankanon, K., Pittayanon, R., Faknak, N. et al. Diagnostic validity and learning curve of non-NBI expert endoscopists in gastric intestinal metaplasia diagnosis. Surg Endosc 37, 6771–6778 (2023). https://doi.org/10.1007/s00464-023-10123-9

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  • DOI: https://doi.org/10.1007/s00464-023-10123-9

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