Background and study aim
The establishment of precise and valid diagnostic criteria is the first step towards understanding the pathogenesis of Barrett’s esophagus in Asia. The present study determined the interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus among Asian endoscopists.
Patients and methods
Video clips of endoscopy in 21 patients with and without Barrett’s esophagus were used for training (n=3) and standardized diagnosis and grading (n=18) of Barrett’s esophagus by endoscopists from seven hospitals in different Asian regions/countries. Barrett’s esophagus, where present, was graded using the Prague C & M Criteria whereby the circumferential extent of 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.
A total of 34 endoscopists participated. The ICC values for the scores of C value, M value, location of the gastroesophageal junction, and location of the diaphragmatic hiatus were 0.92 (95% CI, 0.88–0.97), 0.94 (0.90–0.98), 0.86 (0.78–0.94), and 0.81 (0.71–0.92), respectively, indicating excellent interobserver reliability. The differences in region/country, experience of endoscopists, volume of participating center, or the primary practice type did not have significant effect on the reliability. The ICC values for recognition of Barrett’s esophagus with an extent ≥1 cm were 0.90 (0.80–1.00) and 0.92 (0.87–0.98) for the C and M values, respectively, whereas the corresponding ICC values for Barrett’s segment <1 cm were 0.18 (0.03–0.32) and 0.21 (0.00–0.51), respectively.
Despite the relatively uncommon occurrence of Barrett’s esophagus in Asia, endoscopists in our study exhibited excellent consistency in the endoscopic diagnosis and grading of Barrett’s esophagus using the Prague C & M Criteria. In view of the low interobserver reliability in recognizing Barrett’s esophagus segments of <1 cm, future studies in Asia should take this into account in their selection strategies as to recruit as homogeneous a population for study as possible.