Endoscopy 2004; 36(2): 160-164
DOI: 10.1055/s-2004-814183
Original Article
© Georg Thieme Verlag Stuttgart · New York

Inter- and Intra-Observer Variability of Magnification Chromoendoscopy for Detecting Specialized Intestinal Metaplasia at the Gastroesophageal Junction

A.  Meining1 , T.  Rösch2 , R.  Kiesslich3 , M.  Muders4 , F.  Sax1 , W.  Heldwein1
  • 1Dept. of Medicine, City Center Hospital/University of Munich, Munich, Germany
  • 2Dept. of Medicine II, Technical University of Munich, Munich, Germany
  • 3Dept. of Medicine I, University of Mainz, Mainz, Germany
  • 4Dept. of Pathology, University of Munich, Munich, Germany
Further Information

Publication History

Submitted 20 August 2003

Accepted after Revision 13 November 2003

Publication Date:
06 February 2004 (online)

Abstract

Background and Study Aims: Magnification endoscopy after contrast enhancement with acetic acid or staining with methylene blue has been reported to be highly accurate in predicting specialized intestinal metaplasia (SIM) in Barrett’s esophagus. So far, however, no data have been published on the interobserver and intra-observer variability of these new methods.
Patients and Methods: Fifty-one patients with reflux symptoms were prospectively evaluated. Endoscopy was carried out with a magnification endoscope, and video sequences were recorded in standard and zoom modes (at the 12-o’clock, 3-o’clock, 6-o’clock, and 9-o’clock positions) before and after instillation of 1.5 % acetic acid (n = 26) or staining with 0.5 % methylene blue (n = 25). Biopsies were obtained from the same locations for histopathological examination. The 102 video sequences were shown to four experienced endoscopists in a mixed and blinded fashion. The evaluation criteria used followed the published criteria; classification was carried out according to the pit-pattern structure, methylene blue positivity, and the presence of villous structures. Finally, a general statement on suspected SIM in relation to Barrett’s esophagus was requested.
Results: With regard to the criteria selected for evaluation, there was a high level of interobserver variability among the four examiners (all kappa < 0.4). SIM was histologically detectable in 60.8 % of the patients. The accuracy of all of the examiners for predicting SIM by magnification endoscopy was around 50 %, with no differences observed before and after instillation of acetic acid or methylene blue staining.
Conclusions: The suggested criteria for identifying SIM using magnification endoscopy are associated with a high level of interobserver variability. When evaluated in a blinded manner, staining techniques do not significantly improve the yield for detecting SIM at the esophagogastric junction.

References

  • 1 Spechler S J, Goyal R K. Barrett’s esophagus.  N Engl J Med. 1986;  315 362-371
  • 2 Sampliner R E. Practice ParametersCommittee of the American College of Gastroenterology. Updated practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus.  Am J Gastroenterol. 2002;  97 1888-1895
  • 3 Eloubeide M A, Provenzale D. Does this patient have Barrett’s esophagus? The utility of predicting Barrett’s esophagus at the index endoscopy.  Am J Gastroenterol. 1999;  94 937-943
  • 4 Corley D A, Levin T R, Habel L A. et al . Surveillance and survival in Barrett’s adenocarcinomas: a population-based study.  Gastroenterol. 2002;  122 633-640
  • 5 Endo T, Awakawa T, Takahashi H. et al . Classification of Barrett’s epithelium by magnifying endoscopy.  Gastrointest Endosc. 2002;  55 641-647
  • 6 Sharma P, Weston A P, Topalovski M. et al . Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett’s oesophagus.  Gut. 2003;  52 24-27
  • 7 Guelrud M, Herrera I, Essenfeld H, Castro J. Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett’s esophagus.  Gastrointest Endosc. 2001;  53 559-565
  • 8 Guelrud M, Herrera I, Essenfeld H. et al . Intestinal metaplasia of the gastric cardia: a prospective study with enhanced magnification endoscopy.  Am J Gastroenterol. 2002;  97 584-589
  • 9 Dixon M F, Genta R M, Yardley J H. et al . Classification and grading of gastritis: the updated Sydney System.  Am J Surg Pathol. 1996;  20 1161-1181
  • 10 Meining A, Dittler H J, Wolf A. et al . You get what you expect? A critical appraisal of imaging methodology in endosonographic cancer staging.  Gut. 2002;  50 599-603
  • 11 Meining A, Rösch T, Wolf A. et al . High interobserver variability in endosonographic staging of upper gastrointestinal cancers.  Z Gastroenterol. 2003;  41 391-394
  • 12 Breyer H P, Silva De Barros S G, Maguilnik I, Edelweiss M I. Does methylene blue detect intestinal metaplasia in Barrett’s esophagus?.  Gastrointest Endosc. 2003;  57 505-509.
  • 13 Morales C P, Spechler S J. Intestinal metaplasia at the gastroesophageal junction: Barrett’s, bacteria, and biomarkers.  Am J Gastroenterol. 2003;  98 759-762
  • 14 Shaheen N. Is there a ”Barrett’s iceberg”?.  Gastroenterology. 2002;  123 636-638
  • 15 Zuccaro G, Gladkova N, Vargo J. et al . Optical coherence tomography of the esophagus and proximal stomach in health and disease.  Am J Gastroenterol. 2001;  96 2633-2639
  • 16 Das A, Sivak M V, Chak A. et al . High-resolution endoscopic imaging of the GI tract: a comparative study of optical coherence tomography versus high-frequency catheter probe EUS.  Gastrointest Endosc. 2001;  54 219-224
  • 17 George M, Meining A. Cresyl violet as a fluorophore for future in vivo histopathology.  Endoscopy. 2003;  35 585-589

A. Meining, M. D. 

Medizinische Klinik - Innenstadt

University of Munich · Ziemssenstraße 1 · 80336 München · Germany

Fax: +49-89-5160-2105

Email: ameining@medinn.med.uni-muenchen.de

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