根据内镜经验水平和培训效果评估内镜诊断幽门螺杆菌感染的准确性。
Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training.
机构信息
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
出版信息
BMC Gastroenterol. 2013 Aug 15;13:128. doi: 10.1186/1471-230X-13-128.
BACKGROUND
Accurate prediction of Helicobacter pylori infection status on endoscopic images can contribute to early detection of gastric cancer, especially in Asia. We identified the diagnostic yield of endoscopy for H. pylori infection at various endoscopist career levels and the effect of two years of training on diagnostic yield.
METHODS
A total of 77 consecutive patients who underwent endoscopy were analyzed. H. pylori infection status was determined by histology, serology, and the urea breast test and categorized as H. pylori-uninfected, -infected, or -eradicated. Distinctive endoscopic findings were judged by six physicians at different career levels: beginner (<500 endoscopies), intermediate (1500-5000), and advanced (>5000). Diagnostic yield and inter- and intra-observer agreement on H. pylori infection status were evaluated. Values were compared between the two beginners after two years of training. The kappa (K) statistic was used to calculate agreement.
RESULTS
For all physicians, the diagnostic yield was 88.9% for H. pylori-uninfected, 62.1% for H. pylori-infected, and 55.8% for H. pylori-eradicated. Intra-observer agreement for H. pylori infection status was good (K > 0.6) for all physicians, while inter-observer agreement was lower (K = 0.46) for beginners than for intermediate and advanced (K > 0.6). For all physicians, good inter-observer agreement in endoscopic findings was seen for atrophic change (K = 0.69), regular arrangement of collecting venules (K = 0.63), and hemorrhage (K = 0.62). For beginners, the diagnostic yield of H. pylori-infected/eradicated status and inter-observer agreement of endoscopic findings were improved after two years of training.
CONCLUSIONS
The diagnostic yield of endoscopic diagnosis was high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases. In beginners, daily training on endoscopic findings improved the low diagnostic yield.
背景
准确预测内镜图像中幽门螺杆菌感染状态有助于早期发现胃癌，尤其是在亚洲。我们确定了不同内镜医生职业生涯阶段内镜检查对幽门螺杆菌感染的诊断效果，并研究了两年培训对诊断效果的影响。
方法
共分析了 77 例连续接受内镜检查的患者。通过组织学、血清学和尿素呼气试验确定幽门螺杆菌感染状态，并将其分为幽门螺杆菌未感染、感染和根除。由 6 名不同职业生涯水平的医生判断特征性内镜发现：初学者（<500 例内镜检查）、中级（1500-5000 例）和高级（>5000 例）。评估了幽门螺杆菌感染状态的诊断效果和观察者间及观察者内的一致性。比较了经过两年培训后的两名初学者之间的值。使用kappa（K）统计量计算一致性。
结果
对于所有医生，幽门螺杆菌未感染的诊断率为 88.9%，幽门螺杆菌感染的诊断率为 62.1%，幽门螺杆菌根除的诊断率为 55.8%。所有医生对幽门螺杆菌感染状态的观察者内一致性良好（K>0.6），而观察者间一致性较低（K=0.46），初学者低于中级和高级（K>0.6）。对于所有医生，萎缩性改变（K=0.69）、收集静脉的规则排列（K=0.63）和出血（K=0.62）的内镜发现具有良好的观察者间一致性。经过两年的培训，初学者的幽门螺杆菌感染/根除状态的诊断率和内镜发现的观察者间一致性得到提高。
结论
内镜诊断对幽门螺杆菌未感染病例的诊断效果较高，但对幽门螺杆菌根除病例的诊断效果较低。在初学者中，对内镜发现的日常培训提高了较低的诊断率。
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