Inter-institutional variations regarding Barrett's esophagus diagnosis

Area of Science:

• Gastroenterology
• Medical Diagnostics
• Oncology

Background:

• Barrett's esophagus (BE) is a premalignant condition for esophageal adenocarcinoma.
• Accurate diagnosis of BE is crucial for patient surveillance and risk stratification.
• Variability in diagnostic accuracy among endoscopy units may impact patient care.

Purpose of the Study:

• To investigate inter-institutional variability in the endoscopic diagnosis of Barrett's esophagus.
• To assess the accuracy of BE diagnosis across four different hospitals.
• To evaluate the relationship between diagnostic accuracy and endoscopist experience.

Main Methods:

• Retrospective review of endoscopic images from approximately 500 patients per hospital.
• Independent review by six expert endoscopists to establish a consensus diagnosis.
• Comparison of expert consensus diagnosis with on-site endoscopist diagnoses and calculation of concordance.

Main Results:

• Significant variation in BE diagnosis prevalence (17.2-96.8%) across hospitals.
• Diagnostic accuracy by on-site endoscopists ranged from 44.6% to 83.1%.
• Over-diagnosis was noted in one hospital, while under-diagnosis occurred in two; no association found between accuracy and endoscopist experience.

Conclusions:

• Diagnostic accuracy for Barrett's esophagus is not uniform across institutions.
• Over-diagnosis and under-diagnosis are significant issues that require attention.
• Current findings highlight the need for standardized diagnostic criteria and quality control in BE diagnosis.