Endoscopic mucosal resection or ablation for Barrett’s esophagus containing high grade dysplasia: agreement strongest among expert gastroenterologists
Background and study aims: Endoscopic mucosal resection (EMR) plays an important role in the staging of Barrett’s esophagus (BE) and the evaluation of high grade dysplasia (HGD). The study aim is to assess the interobserver agreement among...
Main Authors: | , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Georg Thieme Verlag KG
2014-09-01
|
Series: | Endoscopy International Open |
Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1377516 |
Summary: | Background and study aims: Endoscopic mucosal resection (EMR) plays an
important role in the staging of Barrett’s esophagus (BE) and the evaluation of
high grade dysplasia (HGD). The study aim is to assess the interobserver
agreement among gastroenterologists expert in BE endotherapy,
gastroenterologists without specified expertise in BE endotherapy, and
gastroenterology trainees in recommending EMR vs ablation for BE HGD lesions,
and to assess the effect of a one-time educational intervention on the
interobserver agreement among non-experts and trainees.
Patients and methods: An electronic survey containing 30 still endoscopic
images of BE HGD was sent to three groups of respondents: experts, non-experts,
and trainees. Respondents were asked to select “Endoscopic Mucosal Resection” or
“Ablation” as the most appropriate next step in management. Non-experts and
trainees were then invited to repeat the survey following an educational
intervention. The main outcome measure was interobserver agreement measured by
Fleiss’ Kappa statistic and percent agreement.
Results: In selecting between EMR and ablation, on the pre-intervention
survey there was the highest amount of agreement among experts (kappa = 0.437),
followed by agreement among trainees (kappa = 0.281), and non-experts
(kappa = 0.107). Experts demonstrated significantly higher agreement compared to
either trainees (P < 0.001) or non-experts (P < 0.001). On
the post-intervention survey, interobserver agreement remained low among both
trainees (kappa = 0.20) and non-experts (kappa = 0.14). Comparing the results of
the surveys, there was no evidence that agreement differed for either trainees
or non-experts.
Conclusions: Future efforts are needed to enable endoscopist recognition
of BE HGD lesions. Consensus guidelines alone are insufficient in directing
preferred endoscopic management of BE HGD. |
---|---|
ISSN: | 2364-3722 2196-9736 |