Original ArticleWhich landmark results in a more consistent diagnosis of Barrett's esophagus, the gastric folds or the palisade vessels?
Section snippets
Materials and methods
Eighty-four endoscopists, in practice from 2 to 35 years (median, 10 years), were enrolled in this study. Study participants were divided into groups according to years in practice as an endoscopist, presence or absence of board certification from the Japan Gastroenterological Endoscopy Society (JGES), and whether they had taken any special endoscopic training courses on esophagitis. Endoscopists receive board certification from the JGES after completing 5 years of training in a JGES-approved
Results
The degree of experience with diagnostic endoscopy of the 84 endoscopists is shown in Table 1. Forty-eight endoscopists were considered experienced. Twenty-one were board licensed by JGES and were considered experts. Twenty-seven had received training at Shimane University Hospital on the endoscopic diagnosis of GERD.
The overall kappa value and the 95% CI for endoscopist definition of the GEJ on the 30 photographs was 0.14 (0.13-0.16), as shown in Figure 3. The participants identified the GEJ
Discussion
The longitudinal esophageal palisade vessels, present in the mucosal layer of the lower esophagus, disappear into the submucosal layer at the GEJ.19, 20 Therefore, in Japan, the distal end of palisade vessels is considered to be the endoscopic landmark of the GEJ. The palisade vessels, however, can be difficult to identify endoscopically, particularly in BE where inflammation or mucosal dysplastic change may obscure them. Insufficient air inflation can also render them difficult to visualize.16
Acknowledgments
The authors thank Mr T. Kato (AstraZeneca Co, Ltd, Japan) for the excellent statistical support provided.
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