J Korean Med Sci.  2013 May;28(5):744-749. 10.3346/jkms.2013.28.5.744.

Interobserver Variability and Accuracy of High-Definition Endoscopic Diagnosis for Gastric Intestinal Metaplasia among Experienced and Inexperienced Endoscopists

• Hyun YS
• Han DS
• Bae JH
• Park HS
• Eun CS

• KMID: 1777563
• DOI: http://doi.org/10.3346/jkms.2013.28.5.744

Abstract

Accurate diagnosis of gastric intestinal metaplasia is important; however, conventional endoscopy is known to be an unreliable modality for diagnosing gastric intestinal metaplasia (IM). The aims of the study were to evaluate the interobserver variation in diagnosing IM by high-definition (HD) endoscopy and the diagnostic accuracy of this modality for IM among experienced and inexperienced endoscopists. Selected 50 cases, taken with HD endoscopy, were sent for a diagnostic inquiry of gastric IM through visual inspection to five experienced and five inexperienced endoscopists. The interobserver agreement between endoscopists was evaluated to verify the diagnostic reliability of HD endoscopy in diagnosing IM, and the diagnostic accuracy, sensitivity, and specificity were evaluated for validity of HD endoscopy in diagnosing IM. Interobserver agreement among the experienced endoscopists was "poor" (kappa = 0.38) and it was also "poor" (kappa = 0.33) among the inexperienced endoscopists. The diagnostic accuracy of the experienced endoscopists was superior to that of the inexperienced endoscopists (P = 0.003). Since diagnosis through visual inspection is unreliable in the diagnosis of IM, all suspicious areas for gastric IM should be considered to be biopsied. Furthermore, endoscopic experience and education are needed to raise the diagnostic accuracy of gastric IM.

Keyword

Gastric Mucosa; Metaplasia; Gastroscopy; Observer Variation; Sensitivity; Specificity

MeSH Terms

Adult
Aged
Endoscopy, Gastrointestinal
Female
Humans
Intestinal Mucosa/*pathology
Male
Metaplasia/*diagnosis/epidemiology
Middle Aged
Observer Variation
Physicians
Stomach/*pathology

Figure

• 

  Fig. 1 Flow diagram of the process of image evaluation.

• 

  Fig. 2 Examples of a high-definition endoscopic case consisting of four images for interpretation. The close-up image shows the sharp mucosal surface of the biopsy site. The three other images include the site of biopsy from different angles and distances. (A) Nine out of 10 endoscopists agreed with the diagnosis of gastric IM on the anterior wall of lower body, and histopathology proved to be marked IM. (B) Two out of 10 endoscopists agreed with the diagnosis of gastric IM on the great curvature of antrum, and histopathology proved to be moderate IM.

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