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由肠胃病学员进行的关于Barrett食管內镜下分类的布拉格C&M标准验证:一项多中心研究

发布日期:2014-1-29 12:40:24 文章来源:GIE 作者次数:1610
    由肠胃病学员进行的关于Barrett食管內镜下分类的布拉格C&M标准验证:一项多中心研究

    背景

    布拉格CM标准是为Barrett食管(BE)的內镜分类而制定的,其中C为全周长,M为最大长度。布拉格CM标准先前是由对BE有浓厚兴趣的29位专家级內镜医师证实的。然而这个标准对肠胃病学员来说是否适用还不明确。

    目的

    为测定胃肠病学员对布拉格C&M标准,以及对胃食管结合部(GEJ)和膈肌裂孔识别的观察一致性。

    设计

    一项前瞻性研究

    环境

    两所三级转诊中心。

    患者与干预

    采用标准内镜视频。

    主要测量指标

    观察者间的一致性。

    结果

    18位胃肠病学员接受由一位专家级內镜医师提供的正式教学模块后,他们对18份高品质视频(正常食管,较短和较长的BE均匀分布)进行了评估,具体分配如下:接受培训1年的,评估5份视频,2年的,评估6份,3年的,评估7份。评估內镜下GEJ以上BE段的CM长度的总体同类相关系数分别为0.9495% 置信区间(CI)为0.89-0.98)和0.9695% CI0.94-0.98)。GEJ和膈肌裂孔位置识别的总体同类相关系数分别为0.92 (0.86-0.96)0.90 (0.82-0.95)。培训年限不会影响观察者之间的一致性。

    局限性

    內镜评估视频的应用。

    结论

    对接受过标准教学的胃肠镜学员来说,布拉格C&M标准总体可信度较高,这与他们在內镜评估可视化BE长度培训上所取得的级别和他们在內镜方面的突出造诣无关。

    缩写词:BEBarret食管;Cl,置信区间;EAC,食管腺癌;GEJ,胃食管交界处;ICC,同类相关系数。

     

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    Validation of the Prague C & M criteria for the endoscopic grading of Barretts esophagus by gastroenterology trainees: a multicenter study

    Background

    The Prague C & M criteria, developed for the endoscopic grading of Barretts esophagus (BE), (C = circumferential length, M = maximal length) were previously validated among a panel of 29 expert endoscopists with a special interest in BE. Its performance among gastroenterology trainees is unknown.

    Objective

    To test interobserver agreement among gastroenterology trainees for the Prague C & M criteria, identification of the gastroesophageal junction (GEJ) and the diaphragmatic hiatus.

    Design

    A prospective study.

    Setting

    Two tertiary referral centers.

    Patients and Interventions

    Standardized endoscopic videos were used.

    Main Outcome Measurements

    Interobserver agreement.

    Results

    Eighteen high-quality videos (normal esophagus, short and long lengths of BE, equally distributed) were independently evaluated by 18 gastroenterology trainees (year 1, n = 5; year 2, n = 6; year 3, n = 7) after administration of a formal teaching module by an expert endoscopist. Overall intraclass correlation coefficients for assessment of the C and M extent of the endoscopic BE segment above the GEJ were 0.94 (95% CI, 0.89-0.98) and 0.96 (95% CI, 0.94-0.98), respectively. The overall intraclass correlation coefficients for GEJ and diaphragmatic hiatus location recognition were 0.92 (0.86-0.96) and 0.90 (0.82-0.95), respectively. The year of training did not affect interobserver agreement.

    Limitations

    The use of videos for endoscopic evaluation.

    Conclusion

    After standardized teaching, the Prague C & M criteria have high overall validity among gastroenterology trainees irrespective of the level of training for endoscopic evaluation of visualized BE lengths as well as key endoscopic landmarks.

    Abbreviations:  BE, Barretts esophagus, CI, confidence interval, EAC, esophageal adenocarcinoma, GEJ, gastroesophageal junction, ICC, intraclass correlation coefficient

     

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