Endoscopy 2017; 49(10): 957-967
DOI: 10.1055/s-0043-111888
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of an e-learning system for diagnosis of gastric lesions using magnifying narrow-band imaging: a multicenter randomized controlled study

Hiroyoshi Nakanishi1, Hisashi Doyama1, Hideki Ishikawa2, Noriya Uedo3, Takuji Gotoda4, Mototsugu Kato5, Shigeaki Nagao6, Yasuaki Nagami7, Hiroyuki Aoyagi8, Atsushi Imagawa9, Junichi Kodaira10, Shinya Mitsui11, Nozomu Kobayashi12, Manabu Muto13, Hajime Takatori14, Takashi Abe15, Masahiko Tsujii16, Jiro Watari17, Shuhei Ishiyama18, Ichiro Oda19, Hiroyuki Ono20, Kazuhiro Kaneko21, Chizu Yokoi22, Tetsuya Ueo23, Kunihisa Uchita24, Kenshi Matsumoto25, Takashi Kanesaka26, Yoshinori Morita27, Shinichi Katsuki28, Jun Nishikawa29, Katsuhisa Inamura30, Tetsu Kinjo31, Katsumi Yamamoto32, Daisuke Yoshimura33, Hiroshi Araki34, Hiroshi Kashida35, Ayumu Hosokawa36, Hirohito Mori37, Haruhiro Yamashita38, Osamu Motohashi39, Kazuhiko Kobayashi40, Michiaki Hirayama41, Hiroyuki Kobayashi42, Masaki Endo43, Hiroo Yamano44, Kazunari Murakami45, Tomoyuki Koike46, Kingo Hirasawa47, Youichi Miyaoka48, Hidetaka Hamamoto49, Takuto Hikichi50, Norihiro Hanabata51, Ryo Shimoda52, Shinichiro Hori53, Tadashi Sato54, Shinya Kodashima55, Hiroyuki Okada56, Tomohiko Mannami57, Shojiro Yamamoto58, Yasumasa Niwa59, Kazuo Yashima60, Satoshi Tanabe61, Hiro Satoh62, Fumisato Sasaki63, Tetsuro Yamazato64, Yoshiou Ikeda65, Hogara Nishisaki66, Masahiro Nakagawa67, Akio Matsuda68, Fumio Tamura69, Hitoshi Nishiyama70, Keiko Arita71, Keisuke Kawasaki72, Kazushige Hoppo73, Masashi Oka74, Shinichi Ishihara75, Michita Mukasa76, Hiroaki Minamino77, Kenshi Yao78
  • 1Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
  • 2Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • 3Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
  • 4Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  • 5Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
  • 6Department of Internal Medicine, National Defense Medical College, Saitama, Japan
  • 7Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
  • 8Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
  • 9Department of Gastroenterology, Mitoyo General Hospital, Kan-onji, Japan
  • 10Department of Gastroenterology, Keiyukai Sapporo Hospital, Sapporo, Japan
  • 11Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
  • 12Department of Diagnostic Imaging, Tochigi Cancer Center, Utsunomiya, Japan
  • 13Department of Clinical oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 14Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
  • 15Department of Gastroenterology, Takarazuka Municipal Hospital, Takarazuka, Japan
  • 16Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
  • 17Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
  • 18Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
  • 19Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  • 20Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
  • 21Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
  • 22Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
  • 23Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan
  • 24Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
  • 25Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
  • 26Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
  • 27Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
  • 28Center of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan
  • 29Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
  • 30Department of Gastroenterology, Tonami General Hospital, Tonami, Japan
  • 31Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
  • 32Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
  • 33Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
  • 34Division of Endoscopy, Gifu University Hospital, Gifu, Japan
  • 35Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan
  • 36Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, Toyama, Japan
  • 37Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
  • 38Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
  • 39Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
  • 40Department of Gastroenterology, Matsusaka Chuo General Hospital, Matsusaka, Japan
  • 41Department of Gastroenterological Medicine, Tonan Hospital, Sapporo, Japan
  • 42Division of Gastroenterology, Fukuoka Sanno Hospital, Fukuoka, Japan
  • 43Department of Gastroenterology and Hepatology, School of Medicine, Iwate Medical University, Morioka, Japan
  • 44Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan
  • 45Department of Gastroenterology, Oita University, Yufu, Japan
  • 46Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
  • 47Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
  • 48Department of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
  • 49Digestive Endoscopy Center, Sendai Kousei Hospital, Sendai, Japan
  • 50Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
  • 51Department of Gastroenterology and Hepatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
  • 52Departments of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
  • 53Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
  • 54Department of Gastroenterology and Division of Endoscopy, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
  • 55Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  • 56Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
  • 57Department of Gastroenterology, Chugoku Central Hospital, Fukuyama, Japan
  • 58Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • 59Departments of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
  • 60Department of Gastroenterology, Tottori University Hospital, Yonago, Japan
  • 61Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
  • 62Department of Gastroenterology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
  • 63Department of Gastroenterology, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
  • 64Department of Gastroenterology, Tokyo Metropolitan Cancer Detection Center, Tokyo, Japan
  • 65Endoscopy Center, Ehime University Hospital, Toon, Japan
  • 66Department of Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan
  • 67Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan
  • 68Department of Gastroenterology, Nanpuh Hospital, Kagoshima, Japan
  • 69Division of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan
  • 70Department of Gastroenterology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
  • 71Arita Gastro-intestinal Hospital, Oita, Japan
  • 72Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
  • 73Division of Gastroenterology, Yamatotakada Municipal Hospital, Yamatotakada, Japan
  • 74Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
  • 75Ishihara Gastroenterology Clinic, Zentsuji, Japan
  • 76Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
  • 77Department of Gastroenterology, Izumiotsu Municipal Hospital, Izumiotsu, Japan
  • 78Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
Further Information

Publication History

submitted 07 December 2016

accepted after revision 01 May 2017

Publication Date:
21 June 2017 (eFirst)

Abstract

Background and study aim Magnifying narrow-band imaging (M-NBI) is useful for the accurate diagnosis of early gastric cancer (EGC). However, acquiring skill at M-NBI diagnosis takes substantial effort. An Internet-based e-learning system to teach endoscopic diagnosis of EGC using M-NBI has been developed. This study evaluated its effectiveness.

Participants and methods This study was designed as a multicenter randomized controlled trial. We recruited endoscopists as participants from all over Japan. After completing Test 1, which consisted of M-NBI images of 40 gastric lesions, participants were randomly assigned to the e-learning or non-e-learning groups. Only the e-learning group was allowed to access the e-learning system. After the e-learning period, both groups received Test 2. The analysis set was participants who scored < 80 % accuracy on Test 1. The primary end point was the difference in accuracy between Test 1 and Test 2 for the two groups.

Results A total of 395 participants from 77 institutions completed Test 1 (198 in the e-learning group and 197 in the non-e-learning group). After the e-learning period, all 395 completed Test 2. The analysis sets were e-learning group: n = 184; and non-e-learning group: n = 184. The mean Test 1 score was 59.9 % for the e-learning group and 61.7 % for the non-e-learning group. The change in accuracy in Test 2 was significantly higher in the e-learning group than in the non-e-learning group (7.4 points vs. 0.14 points, respectively; P < 0.001).

Conclusion This study clearly demonstrated the efficacy of the e-learning system in improving practitioners’ capabilities to diagnose EGC using M-NBI.

Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000008569).