Gastroenterology

Gastroenterology

Volume 156, Issue 5, April 2019, Pages 1299-1308.e3
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
An Interactive Web-Based Educational Tool Improves Detection and Delineation of Barrett’s Esophagus–Related Neoplasia

https://doi.org/10.1053/j.gastro.2018.12.021Get rights and content

Background & Aims

Endoscopic detection of early Barrett’s esophagus-related neoplasia (BORN) is a challenge. We aimed to develop a web-based teaching tool for improving detection and delineation of BORN.

Methods

We made high-definition digital videos during endoscopies of patients with BORN and non-dysplastic Barrett’s esophagus. Three experts superimposed their delineations of BORN lesions on the videos using special tools. In phase one, 68 general endoscopists from 4 countries assessed 4 batches of 20 videos. After each batch, mandatory feedback compared the assessors’ interpretations with those from experts. These data informed the selection of 25 videos for the phase 2 module, which was completed by 121 new assessors from 5 countries. A 5-video test batch was completed before and after scoring of the four 5-video training batches. Mandatory feedback was as in phase 1. Outcome measures were scores for detection, delineation, agreement delineation, and relative delineation of BORN.

Results

A linear mixed-effect model showed significant sequential improvement for all 4 outcomes over successive training batches in both phases. In phase 2, median detection rates of BORN in the test batch increased by 30% (P < .001) after training. From baseline to the end of the study, there were relative increases in scores of 46% for detection, 129% for delineation, 105% for agreement delineation, and 106% for relative delineation (all, P < .001). Scores improved independent of assessors’ country of origin or level of endoscopic experience.

Conclusions

We developed a web-based teaching tool for endoscopic recognition of BORN that is easily accessible, efficient, and increases detection and delineation of neoplastic lesions. Widespread use of this tool might improve management of Barrett’s esophagus by general endoscopists.

Section snippets

Setting and Design

For the BORN project, a subgroup of the IWGCO was formed consisting of the authors of this paper. Members of this subgroup convened several times a year between 2005 and 2015. The first step was the development of an endoscopic pullback imaging protocol tailored to the needs of this project during several meetings.

Endoscopic Videorecordings

High-quality videos containing BORN and non-dysplastic BE (NDBE) were then prospectively collected with the standardized endoscopic pullback procedure, which was illustrated by an

Assessment of the Phase 1 Draft Training Module

A total of 68 assessors from The Netherlands (n = 46), United Kingdom (n = 8), Germany (n = 10), and United States (n = 4) completed the draft training module in full. They were classed in 3 categories of endoscopic experience: trainees (fellows in training), junior general gastroenterologists (board certified ≤2 years of practice), and senior general gastroenterologists (≥5 years in practice) (Table 1).

Discussion

This paper first describes the demanding processes involved in the development of an educational module for the endoscopic diagnosis of early BORN. The module was designed for automated online delivery of high-definition videos, their scoring, and provision of feedback on the endoscopic judgments made by training participants. Second, we report on validation studies that led to refinement of the phase 1 draft training program to the final phase 2 condensed educational module. This module has

Acknowledgments

Author contribution: Study design: J. J. Bergman, O. Pech, K. Ragunath, D. Armstrong, L. Lundell, J. Dent, M. Vieth, G. N. Tytgat, P. Sharma. Patient recruitment and video collection: J. J. Bergman, O. Pech, P. Sharma. Video review: J. J. Bergman, O. Pech, K. Ragunath, G. Tytgat, P. Sharma. Video delineation: J. J. Bergman, O. Pech, K. Ragunath, P. Sharma. Data analysis and interpretation: J. J. Bergman, A.J. de Groof, N. Mostafavi. Writing of manuscript: J. J. Bergman, A.J. de Groof, N.

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Conflicts of interest This study was supported by unrestricted grants from AstraZeneca and Medtronic, and by an educational activity grant from the United European Gastroenterology, which had no involvement in the design, recruitment, data collection, analysis or interpretation or writing of the manuscript.

Authors share first authorship.

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