慢性萎缩性胃炎内镜下木村-竹本分型诊断异质性研究

Interobserver Variability in Chronic Atrophic Gastritis Diagnosis with Kimura-Takemoto Endoscopic Classification

摘要:

目的 分析不同年资内镜医生内镜下诊断慢性萎缩性胃炎(Chronic Atrophy Gastritis,CAG)的准确率是否存在异质性。方法? 回顾性收集2021年1月-2024年6月于陆军军医大学第一附属医院消化内镜中心、武汉大学人民医院消化内镜中心、山西省煤炭中心医院消化内镜中心完善电子胃镜检查的慢性萎缩性胃炎(CAG)及非慢性萎缩性胃炎(non-CAG)患者的内镜检查资料,共计纳入病例247例。将所收集的病例交予由三名资深内镜医生组成的“专家组”确定的最终诊断为标准。三个中心共计14名内镜医生对前述病例做出内镜下诊断,根据既往完成电子胃镜检查操作的例数分为低年资组7名,高年资组7名,分析两组内镜医生诊断内镜下萎缩性胃炎(Endoscopic Gastric Atrophy,EGA)的准确率差异。结果? 低年资内镜医生的诊断准确率波动在36.4%-72.5%,均值为62.1%,高年资内镜医生的诊断准确率波动在66.0%-86.6%,均值为77.3%,P＜0.001。C型萎缩、O型萎缩、non-CAG的诊断准确率在不同年资内镜医生之间均存在差异。结论? 不同年资内镜医生对于内镜下CAG木村-竹本分型的诊断存在异质性,高年资内镜医生的诊断准确率高于低年资内镜医生。

Abstract:

Objective To analyze interobserver variability in the accuracy of endoscopic diagnosis of chronic atrophic gastritis among endoscopists of different level of experience. Methods The endoscopic examination data of patients who underwent upper gastrointestinal endoscopic examination from 2021 to June 2024 at The First Affiliated Hospital of Army Medical University, Renmin Hospital of Wuhan University and Shanxi Provincial Coal Central Hospital were retrospectively collected. Total 247 cases were included. The collected cases were submitted for review to a panel of experts, which consisted of three members. The final diagnose of this expert group for every case was reviewed as the standard.14 endoscopists from the three previously mentioned centers participated this study, including 7 junior endoscopists and 7 experienced endoscopists. The difference in the accuracy of endoscopic gastric atrophy between junior endoscopists and experienced endoscopists were analyzed. Results Diagnostic accuracy fluctuates from 36.4%-72.5% for junior endoscopists and the average value is 62.1%.Diagnostic accuracy fluctuates from 66.0%-86.6% for experienced endoscopists and the average value is 77.3%,P<0.001.The diagnostic accuracy of C-type atrophy,O-type atrophy and non-CAG all has interobserver variability among endoscopists of different level of experience. Conclusion The diagnostic accuracy of endoscopic gastric atrophy in the experienced endoscopists was higher than junior endoscopists. The interobserver variability in the accuracy of endoscopic diagnosis of chronic atrophic gastritis among endoscopists of different level of experience existed.