Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand.
Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Surg Endosc. 2023 Sep;37(9):6771-6778. doi: 10.1007/s00464-023-10123-9. Epub 2023 May 24.
Endoscopists' experience influences narrow-band imaging (NBI)-guided gastric intestinal metaplasia (GIM) diagnostic performance. We aimed to evaluate the general gastroenterologists (GE) performance in NBI-guided GIM diagnosis compared to NBI experts (XP) and assess GEs' learning curve.
A cross-sectional study was conducted between 10/2019 and 2/2022. Histology-proven GIM who underwent esophagogastroduodenoscopy (EGD) were randomly assessed by 2XPs or 3GEs. Endoscopists' performance on NBI-guided diagnoses were compared to the pathological diagnosis (gold standard) in five areas of the stomach according to the Sydney protocol. The primary outcome were GIM diagnosis validity scores of GEs compared to XPs. The secondary outcome was the minimum number of lesions required for GEs to achieve an accuracy of GIM diagnosis ≥ 80%.
One thousand one hundred and fifty-five lesions from 189 patients (51.3% male, mean age 66 ± 10 years) were examined. GEs performed EGD in 128 patients with 690 lesions. the GIM diagnosis sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GEs compared to the XPs, were 91% vs.93%, 73% vs.83%, 79% vs.83%, 89% vs.93%, and 83% vs.88%, respectively. GEs demonstrated lower specificity (mean difference - 9.4%; 95%CI - 16.3, 1.4; p = 0.008) and accuracy (mean difference - 5.1%; 95%CI - 3.3, 6.3; p = 0.006) compared to XPs. After 100 lesions (50% GIM), GEs achieved an accuracy of ≥ 80% and all diagnostic validity scores were comparable to the XPs (p < 0.05 all).
Compared to XPs, GEs had lower specificity and accuracy for GIM diagnosis. The learning curve for a GE to achieve comparable performance to XPs would necessitate at least 50 GIM lesions. Created with BioRender.com.
内镜医师的经验会影响窄带成像（NBI）指导下的胃肠上皮化生（GIM）的诊断性能。我们旨在评估普通胃肠病学家（GE）在 NBI 指导下的 GIM 诊断表现与 NBI 专家（XP）相比，并评估 GE 的学习曲线。
这是一项在 2019 年 10 月至 2022 年 2 月期间进行的横断面研究。接受食管胃十二指肠镜检查（EGD）的经组织学证实的 GIM 患者被随机由 2 名 XP 或 3 名 GE 评估。根据悉尼协议，内镜医师在胃的五个区域根据 NBI 指导下的诊断与病理诊断（金标准）进行比较。主要结果是与 XP 相比，GE 在 GIM 诊断有效性评分方面的表现。次要结果是 GE 达到 GIM 诊断准确性≥80%所需的最小病变数量。
189 名患者（51.3%为男性，平均年龄 66±10 岁）的 1155 个病变接受了检查。GE 在 128 名患者中进行了 690 个病变的 EGD。与 XP 相比，GE 的 GIM 诊断敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 91%、73%、79%、89%和 83%。GE 表现出较低的特异性（平均差异-9.4%；95%CI-16.3，1.4；p=0.008）和准确性（平均差异-5.1%；95%CI-3.3，6.3；p=0.006）。在 100 个病变（50%的 GIM）后，GE 达到了准确性≥80%，并且所有诊断有效性评分与 XP 相当（p<0.05 均）。
与 XP 相比，GE 对 GIM 的诊断特异性和准确性较低。GE 要达到与 XP 相当的表现，学习曲线至少需要 50 个 GIM 病变。由 BioRender.com 创建。
