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


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 > or = 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.
Lee
Y C
YC
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Cook
M B
MB
Bhatia
S
S
Chow
W H
WH
El-Omar
E M
EM
Goto
H
H
Lin
J T
JT
Li
Y Q
YQ
Rhee
P L
PL
Sharma
P
P
Sung
J J
JJ
Wong
J Y
JY
Wu
J C
JC
Ho
K Y
KY
D001208:Asia; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004945:Esophagoscopy / Q000592:standards*; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results
Dis Esophagus. 2010 Apr;23(3):201-7
19788438
Endoscopy. 2006 Oct;38(10):1032-5
17058170
Gastrointest Endosc. 2009 May;69(6):1004-10
19152897
Gut. 1999 Aug;45(2):172-80
10403727
Endoscopy. 2005 Sep;37(9):879-920
16116544
J Clin Gastroenterol. 2008 Nov-Dec;42(10):1074-9
18360296
Stat Med. 1998 Jan 15;17(1):101-10
9463853
Dis Esophagus. 2008;21(4):355-63
18477259
Gastroenterol Hepatol (N Y). 2008 Jan;4(1):45-53
22798736
Dis Esophagus. 2009;22(8):676-81
19222529
J Gastroenterol Hepatol. 2007 Oct;22(10):1650-5
17845693
Dis Esophagus. 2009;22(4):348-53
19191861
Eur J Gastroenterol Hepatol. 2004 May;16(5):495-501
15097043
Gastroenterology. 1996 Jul;111(1):85-92
8698230
Aliment Pharmacol Ther. 2002 Dec;16(12):2037-42
12452935
Gut. 2008 Mar;57(3):298-305
17965056
Aliment Pharmacol Ther. 2007 Oct 1;26(7):1069-75
17877514
J Clin Gastroenterol. 2009 Nov-Dec;43(10):907-14
19417682
Aliment Pharmacol Ther. 2009 Apr 1;29(7):774-80
19183160
Gastrointest Endosc. 2006 Aug;64(2):206-11
16860070
Gastroenterology. 2002 May;122(5):1500-11
11984534
Int J Epidemiol. 2000 Aug;29(4):645-54
10922340
J Gastroenterol. 2009;44(8):842-6
19504354
Am J Gastroenterol. 2009 Jan;104(1):13-20
19098843
Am J Gastroenterol. 2006 Jul;101(7):1430-6
16863543
J Gastroenterol Hepatol. 2008 Nov;23(11):1662-5
19120859
J Gastroenterol. 2008;43(12):928-34
19107336
J Gastroenterol. 2006 Feb;41(2):95-9
16568367
Gastroenterology. 2006 Nov;131(5):1392-9
17101315
Gastroenterology. 2007 Jul;133(1):11-3
17631123
Gut. 2008 Oct;57(10):1360-5
18441006
Gastrointest Endosc. 2007 Aug;66(2):230-6
17643694
Gut. 2009 Feb;58(2):174-81
18936105
J Gastroenterol Hepatol. 2008 May;23(5):716-22
18410606
Semin Gastrointest Dis. 1997 Apr;8(2):59-67
9109693
Gastrointest Endosc. 2007 Jan;65(1):36-46
17185078
Gut. 2005 Mar;54 Suppl 1:i6-12
15711008
Cancer Epidemiol Biomarkers Prev. 2007 Dec;16(12):2637-40
18086768
Cancer Causes Control. 2010 Feb;21(2):269-74
19866363
Dig Dis Sci. 2010 Jul;55(7):1932-9
19798574
Dig Dis Sci. 2009 Aug;54(8):1702-7
19003532
Nihon Rinsho. 2005 Aug;63(8):1420-6
16101233
Am J Gastroenterol. 1998 Jul;93(7):1033-6
9672325
Gastroenterology. 2007 Mar;132(3):883-9
17324403
Gastrointest Endosc. 2009 May;69(6):1011-3
19410039