Eloubeidi M A, Provenzale D
Center for Health Services Research and Development, Veterans Affairs Medical Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Am J Gastroenterol. 1999 Apr;94(4):937-43. doi: 10.1111/j.1572-0241.1999.990_m.x.
Few studies have evaluated the ability of the endoscopist to predict the presence of Barrett's esophagus (BE) at index endoscopy. The goals of this study were to determine the operating characteristics of endoscopy in diagnosing BE, and to determine the clinical and endoscopic predictors of BE in suspected BE patients at the index endoscopy.
From September 1993 to October 1997, endoscopic reports were examined to identify patients with suspected BE. All esophageal pathology reports during the same period were evaluated for the presence of specialized intestinal metaplasia.
During the study period, 4053 endoscopies were performed on 2393 patients. Eight percent of all procedures were performed for suspected or confirmed BE. Fifty-three patients were known to have BE and thus their reports were excluded from this analysis. Five hundred seventy of the remaining patients had esophageal biopsies performed, and were included in this analysis. Among these 570 patients, 146 were suspected to have BE on endoscopy, while 424 were not suspected to have BE at the time of endoscopy. There were no differences among the two groups in terms of gender, race, and dyspepsia as an indication for the endoscopy. However, suspected BE patients were slightly younger and were more likely to have heartburn, but were less likely to have dysphagia as an indication for the endoscopy. The sensitivity and specificity of the endoscopists' assessments were 82% (95% confidence interval [CI], 72-92) and 81% (95% CI, 78-84), respectively. The positive predictive value and the negative predictive value were 34% and 97%, respectively. The positive likelihood ratio was 4.32 (95% CI, 3.49-5.31) and the negative likelihood ratio was 0.22 (95% CI, 0.13-0.38). Univariate analysis showed that endoscopists diagnosed BE in those with long-segment BE (LSBE) more accurately than in those with short-segment BE (SSBE) (55% vs 25% p = 0.001; odds ratio [OR] = 3.63, 95% CI, 1.71-7.70). Barrett's esophagus was correctly diagnosed in 38.5% of white patients but in only 14.7% of black patients (p = 0.01; OR = 3.63, 95% CI, 1.31-10.13). Multivariable logistic regression identified only the length of the columnar-appearing segment (p = 0.002; OR = 3.33, 95% CI, 1.54-7.17) and race (p = 0.08; OR = 2.31, 95% CI, 0.88-6.03) to be associated with the presence of BE on biopsy.
Barrett's esophagus is frequently suspected at endoscopy; SSBE was more frequently suspected than LSBE, but was correctly diagnosed only 25% of the time, versus 55% for LSBE. Endoscopists diagnosed BE with a sensitivity of 82% and a specificity of 81%. However, the positive predictive value was only 34%, whereas the negative predictive value was 97%. The length of the columnar-appearing segment is the strongest predictor of BE at endoscopy. Alternative methods are needed to better identify BE patients endoscopically, especially those with SSBE.
很少有研究评估内镜医师在初次内镜检查时预测巴雷特食管（BE）存在的能力。本研究的目的是确定内镜检查在诊断BE方面的操作特征，并确定初次内镜检查时疑似BE患者中BE的临床和内镜预测因素。
从1993年9月至1997年10月，检查内镜报告以识别疑似BE的患者。评估同期所有食管病理报告中是否存在特殊肠化生。
在研究期间，对2393例患者进行了4053次内镜检查。所有检查中有8%是针对疑似或确诊的BE进行的。已知有53例患者患有BE，因此他们的报告被排除在本分析之外。其余患者中有570例进行了食管活检，并纳入本分析。在这570例患者中，146例在内镜检查时疑似患有BE，而424例在内镜检查时未被怀疑患有BE。两组在性别、种族和作为内镜检查指征的消化不良方面无差异。然而，疑似BE的患者年龄稍小，更有可能有烧心症状，但作为内镜检查指征出现吞咽困难的可能性较小。内镜医师评估的敏感性和特异性分别为82%（95%置信区间[CI]，72 - 92）和81%（95%CI，78 - 84）。阳性预测值和阴性预测值分别为34%和97%。阳性似然比为4.32（95%CI，3.49 - 5.31），阴性似然比为0.22（95%CI，0.13 - 0.38）。单因素分析显示，内镜医师诊断长段BE（LSBE）患者的BE比短段BE（SSBE）患者更准确（55%对25%，p = 0.001；优势比[OR] = 3.63，95%CI，1.71 - 7.7）。38.5%的白人患者被正确诊断为BE，而黑人患者中只有14.7%（p = 0.01；OR = 3.63，95%CI，1.31 - 10.13）。多变量逻辑回归分析仅确定柱状外观段的长度（p = 0.002；OR = 3.33，95%CI，1.54 - 7.17）和种族（p = 0.08；OR = 2.31，95%CI，0.88 - 6.03）与活检时BE的存在相关。
内镜检查时经常怀疑有巴雷特食管；短段BE比长段BE更常被怀疑，但仅25%的时间能被正确诊断，而长段BE为55%。内镜医师诊断BE的敏感性为82%，特异性为81%。然而，阳性预测值仅为34%，而阴性预测值为97%。柱状外观段的长度是内镜检查时BE最强的预测因素。需要其他方法来更好地在内镜下识别BE患者，尤其是短段BE患者。
