Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training

BMC Gastroenterology

Naomi Uemura⁴  Masashi Mizokami¹  Junichi Akiyama³  Masao Kobayakawa³  Chizu Yokoi³  Naoki Akazawa³  Toshiyuki Sakurai³  Etsuko Furuhata³  Ryo Nakashima³  Takuro Shimbo²  Naoyoshi Nagata³  Kazuhiro Watanabe³ 

[1] Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa City, Chiba 272-8516, Japan;Department of Clinical Research and Informatics, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan;Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan;Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa City, Chiba 272-8516, Japan

关键词: Intra-observer agreement;    Inter-observer agreement;    Endoscopic career level;    Diagnostic yield;    Endoscopic training;    Helicobacter pylori;   

Others  :  857690
DOI  :  10.1186/1471-230X-13-128

 received in 2013-03-07, accepted in 2013-08-08,  发布年份 2013

【 摘 要 】

Background

Accurate prediction of Helicobacter pylori infection status on endoscopic images can contribute to early detection of gastric cancer, especially in Asia. We identified the diagnostic yield of endoscopy for H. pylori infection at various endoscopist career levels and the effect of two years of training on diagnostic yield.

Methods

A total of 77 consecutive patients who underwent endoscopy were analyzed. H. pylori infection status was determined by histology, serology, and the urea breast test and categorized as H. pylori-uninfected, -infected, or -eradicated. Distinctive endoscopic findings were judged by six physicians at different career levels: beginner (<500 endoscopies), intermediate (1500–5000), and advanced (>5000). Diagnostic yield and inter- and intra-observer agreement on H. pylori infection status were evaluated. Values were compared between the two beginners after two years of training. The kappa (K) statistic was used to calculate agreement.

Results

For all physicians, the diagnostic yield was 88.9% for H. pylori-uninfected, 62.1% for H. pylori-infected, and 55.8% for H. pylori-eradicated. Intra-observer agreement for H. pylori infection status was good (K > 0.6) for all physicians, while inter-observer agreement was lower (K = 0.46) for beginners than for intermediate and advanced (K > 0.6). For all physicians, good inter-observer agreement in endoscopic findings was seen for atrophic change (K = 0.69), regular arrangement of collecting venules (K = 0.63), and hemorrhage (K = 0.62). For beginners, the diagnostic yield of H. pylori-infected/eradicated status and inter-observer agreement of endoscopic findings were improved after two years of training.

Conclusions

The diagnostic yield of endoscopic diagnosis was high for H. pylori-uninfected cases, but was low for H. pylori-eradicated cases. In beginners, daily training on endoscopic findings improved the low diagnostic yield.

【 授权许可】

   
2013 Watanabe et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Marshall BJ, Warren JR: Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984, 1:1311-1315.
• [2]Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ: Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001, 345:784-789.
• [3]Uemura N, Mukai T, Okamoto S, Yamaguchi S, Mashiba H, Taniyama K, Sasaki N, Haruma K, Sumii K, Kajiyama G: Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev 1997, 6:639-642.
• [4]Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, Terao S, Amagai K, Hayashi S, Asaka M, Japan Gast Study Group: Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008, 372:392-397.
• [5]Asaka M, Sugiyama T, Nobuta A, Kato M, Takeda H, Graham DY: Atrophic gastritis and intestinal metaplasia in Japan: results of a large multicenter study. Helicobacter 2001, 6:294-299.
• [6]Weck MN, Brenner H: Prevalence of chronic atrophic gastritis in different parts of the world. Cancer Epidemiol Biomarkers Prev 2006, 15:1083-1094.
• [7]Bah A, Saraga E, Armstrong D, Vouillamoz D, Dorta G, Duroux P, Weber B, Froehlich F, Blum AL, Schnegg JF: Endoscopic features of Helicobacter pylori-related gastritis. Endoscopy 1995, 27:593-596.
• [8]Khakoo SI, Lobo AJ, Shepherd NA, Wilkinson SP: Histological assessment of the Sydney classification of endoscopic gastritis. Gut 1994, 35:1172-1175.
• [9]Belair PA, Metz DC, Faigel DO, Furth EE: Receiver operator characteristic analysis of endoscopy as a test for gastritis. Dig Dis Sci 1997, 42:2227-2233.
• [10]Redeen S, Petersson F, Jonsson KA, Borch K: Relationship of gastroscopic features to histological findings in gastritis and Helicobacter pylori infection in a general population sample. Endoscopy 2003, 35:946-950.
• [11]Mihara M, Haruma K, Kamada T, Komoto K, Yoshihara M, Sumii K, Kajiyama G: The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis. Helicobacter 1999, 4:40-48.
• [12]Primignani M, Carpinelli L, Preatoni P, Battaglia G, Carta A, Prada A, Cestari R, Angeli P, Gatta A, Rossi A, Spinzi G, De Franchis R: Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC). Gastroenterology 2000, 119:181-187.
• [13]Laine L: Review article: the effect of Helicobacter pylori infection on nonsteroidal anti-inflammatory drug-induced upper gastrointestinal tract injury. Aliment Pharmacol Ther 2002, 16(Suppl 1):34-39.
• [14]Sotoudehmanesh R, Ali Asgari A, Ansari R, Nouraie M: Endoscopic findings in end-stage renal disease. Endoscopy 2003, 35:502-505.
• [15]Kawai T, Watanabe M, Yamashina A: Impact of upper gastrointestinal lesions in patients on low-dose aspirin therapy: preliminary study. J Gastroenterol Hepatol 2010, 25(Suppl 1):S23-S30.
• [16]Yagi K, Nakamura A, Sekine A: Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol 2002, 17:39-45.
• [17]Kimura K, Takemoto T: An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis. Endoscopy 1969, 1:87-97.
• [18]Kawaguchi H, Haruma K, Komoto K, Yoshihara M, Sumii K, Kajiyama G: Helicobacter pylori infection is the major risk factor for atrophic gastritis. Am J Gastroenterol 1996, 91:959-962.
• [19]Yasunaga Y, Shinomura Y, Kanayama S, Yabu M, Nakanishi T, Miyazaki Y, Murayama Y, Bonilla-Palacios JJ, Matsuzawa Y: Improved fold width and increased acid secretion after eradication of the organism in Helicobacter pylori associated enlarged fold gastritis. Gut 1994, 35:1571-1574.
• [20]Kaminishi M, Yamaguchi H, Nomura S, Oohara T, Sakai S, Fukutomi H, Nakahara A, Kashimura H, Oda M, Kitahora T, Ichikawa H, Yabana T, Yagawa Y, Sugiyama T, Itabashi M, Unakami M, Oguro Y, Sakita T: Endoscopic classification of chronic gastritis based on a pilot study by the research society for gastritis. DIgestive Endoscopy 2002, 14:138-151.
• [21]Watanabe N, Seno H, Nakajima T, Yazumi S, Miyamoto S, Matsumoto S, Itoh T, Kawanami C, Okazaki K, Chiba T: Regression of fundic gland polyps following acquisition of Helicobacter pylori. Gut 2002, 51:742-745.
• [22]Isomoto H, Mizuta Y, Inoue K, Matsuo T, Hayakawa T, Miyazaki M, Onita K, Takeshima F, Murase K, Shimokawa I, Kohno S: A close relationship between Helicobacter pylori infection and gastric xanthoma. Scand J Gastroenterol 1999, 34:346-352.
• [23]Nagata N, Shimbo T, Akiyama J, Nakashima R, Kim HH, Yoshida T, Hoshimoto K, Uemura N: Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy. Gastroenterology Research 2011, 5:203-209.
• [24]Sim J, Wright CC: The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther 2005, 85:257-268.
• [25]Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, Luijt DS, Meyer BC, Kleibeuker JH: Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol 1996, 91:2125-2129.
• [26]Ricci C, Holton J, Vaira D: Diagnosis of Helicobacter pylori: invasive and non-invasive tests. Best Pract Res Clin Gastroenterol 2007, 21:299-313.
• [27]Avunduk C, Navab F, Hampf F, Coughlin B: Prevalence of Helicobacter pylori infection in patients with large gastric folds: evaluation and follow-up with endoscopic ultrasound before and after antimicrobial therapy. Am J Gastroenterol 1995, 90:1969-1973.
• [28]Kosunen TU, Seppala K, Sarna S, Sipponen P: Diagnostic value of decreasing IgG, IgA, and IgM antibody titres after eradication of Helicobacter pylori. Lancet 1992, 339:893-895.
• [29]Miwa H, Ohkura R, Nagahara A, Murai T, Ogihara T, Watanabe S, Hirai S, Sato N: 13C]-urea breath test for assessment of cure of Helicobacter pylori infection at 1 month after treatment. J Clin Gastroenterol 1998, 27(Suppl 1):S150-S153.
• [30]Sidhu R, Sakellariou P, McAlindon ME, Leeds JS, Shafiq K, Hoeroldt BS, Hopper AD, Karmo M, Salmon C, Elphick D, Ali A, Sanders DS: Is formal training necessary for capsule endoscopy? The largest gastroenterology trainee study with controls. Dig Liver Dis 2008, 40:298-302.
• [31]Yamazato T, Oyama T, Yoshida T, Baba Y, Yamanouchi K, Ishii Y, Inoue F, Toda S, Mannen K, Shimoda R, Iwakiri R, Fujimoto K: Two years’ intensive training in endoscopic diagnosis facilitates detection of early gastric cancer. Intern Med 2012, 51:1461-1465.