An educational intervention to improve the endoscopist's ability to correctly diagnose small gastric lesions using magnifying endoscopy with narrow-band imaging

Katsuhiro Mabe, Kenshi Yao, Masanori Nojima, Tokuma Tanuma, Mototsugu Kato, Katsuhiro Mabe, Kenshi Yao, Masanori Nojima, Tokuma Tanuma, Mototsugu Kato

Abstract

Background: Magnifying endoscopy with narrow-band imaging (ME-NBI) and a simple and systematic classification system based on microvascular and microsurface patterns, the "VS" classification system (VSCS), have been shown to be useful for the diagnosis of early gastric cancer. The aim of this study was to clarify whether an educational lecture about the VSCS improves performance with ME-NBI.

Methods: Sixty-four gastrointestinal endoscopists took the 1st exam before receiving the lecture about the VSCS, the 2nd exam immediately after the lecture, and the 3rd exam 2 months after the lecture. We compared the VSCS-based diagnostic accuracy among the participants before and after the lecture.

Results: The proportion of correct diagnoses was significantly higher, at 70.8% in the 2nd exam than in the 1st exam, at 53.1% (P<0.001). The correct diagnosis rate in the 3rd exam was significantly lower than that in the 2nd exam (60.9% vs. 70.8%; P<0.001) but was still higher than that in the 1st exam (60.9% vs. 53.1%; P<0.001). The difference in proportion of correct diagnosis between the 2nd and the 3rd exams was smaller among routine ME-NBI practitioners (n=6; 79.2% and 76.1%, respectively), compared to that among non-routine practitioners (n=34; 71.6% and 59.8%, respectively) or non-practitioners (n=24; 67.5% and 58.8%, respectively).

Conclusion: This study revealed that an educational intervention increased correct diagnosis rate of small gastric lesions using the VSCS, diagnosis criteria based on ME-NBI and also showed that the routine use of the modality and the diagnosis criteria was necessary to maintain diagnostic skills.

Keywords: Magnifying endoscopy; diagnostic performance; educational intervention; gastric cancer; narrow-band imaging.

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Examples of the magnifying endoscopy with narrow-band imaging images of gastric lesions used for the exams. (A) Non-cancerous lesion with a demarcation line but without an irregular microvascular or irregular microsurface pattern (intestinal mataplasia). (B) Gastric cancer with a demarcation line, irregular microvascular and microsuraface patterns
Figure 2
Figure 2
Protocol design of the study. A total of 64 endoscopists (34 specialists and 30 non-specialists) attended the lecture and completed all exams, and were eligible for analysis in this study. They took the 1st exam before receiving the lecture about the microvascular and microsurface classification system, the 2nd exam immediately after the lecture and the 3rd exam 2 months after the lecture
Figure 3
Figure 3
The difference of the accuracy between specialists and non-specialists before and after the lecture. This shows the accuracy as stratified by board-certification status. Accuracy was significantly different between the specialists (56.8%) and the non-specialists (49.0%) before the lecture but no significant difference was observed after the lecture
Figure 4
Figure 4
Proportion of correct diagnoses made in accordance with the VSCS by frequency of use of magnifying endoscopy in each exam. This figure shows the accuracy by frequency of use of magnifying endoscopy in each exam. The difference in diagnostic accuracy between the 2nd and the 3rd exams was smaller among routine magnifying endoscopy with narrow-band imaging practitioners (n=6; 79.2% and 76.1%, respectively), compared to that among non-routine practitioners (n=34; 71.6% and 59.8%, respectively) and non-practitioners (n=24; 67.5% and 58.8%, respectively)

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Source: PubMed

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