title: Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: impact of structured learning and experience on the accuracy of the Amsterdam classification system.
abstract: OBJECTIVE
  Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification.
  
  
  METHODS
  Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given.
  
  
  RESULTS
  Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia.
  
  
  CONCLUSIONS
  Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.
authors.affiliation: Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. fbaldaquesilva@gmail.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Baldaque-Silva
authors.forename: Margarida
authors.initials: M
authors.lastname: Marques
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Themudo
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: José
authors.initials: J
authors.lastname: Soares
authors.forename: Pedro
authors.initials: P
authors.lastname: Bastos
authors.forename: Rosa
authors.initials: R
authors.lastname: Ramalho
authors.forename: Pedro
authors.initials: P
authors.lastname: Pereira
authors.forename: Nuno
authors.initials: N
authors.lastname: Marques
authors.forename: Miguel
authors.initials: M
authors.lastname: Coimbra
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Mario
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Hanns-Ulrich
authors.initials: HU
authors.lastname: Marschall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000145:classification / Q000473:pathology*; D004945:Esophagoscopy / Q000193:education / Q000379:methods; D004947:Esophagus / Q000473:pathology*; D005060:Europe; D005260:Female; D006801:Humans; D007564:Japan; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D062048:Narrow Band Imaging; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014741:Video Recording