Quality of Endoscopic Documentation in Cases of Barrettʼs Esophagus: A Retrospective Analysis
Bibliographic record
Abstract
Introduction: Barrett's esophagus (BE) is incontrovertibly linked to the development of esophageal adenocarcinoma (EAC). The five-year survival amongst patients with EAC remains poor, and therefore screening and endoscopic surveillance are of utmost importance in detecting BE, and preventing progression to EAC. The American College of Gastroenterology (ACG) 2015 Guidelines for Management of BE, and the American Society of Gastrointestinal Endoscopy/ACG 2014 Guidelines on Quality Indicators for Endoscopic Procedures recommend a number of key metrics for the description of BE. The extent of metaplastic change should be reported using the Prague C&M (circumferential and maximal length) Criteria. Endoscopic landmarks should be reported, and final pathology should be reviewed by a GI expert pathologist. The number of biopsies taken is dependent upon the burden of metaplastic change. Methods: This study looked at the adherence to quality indicators for cases of BE. We performed a retrospective chart review of adult patients referred to a provincial esophageal endoscopic ablation program. We collected demographics, and the presence of BE risk factors. Endoscopic and pathologic reports were reviewed to assess for markers of quality endoscopy. The reporting of endoscopic landmarks, Prague C&M criteria, number and location of biopsies taken, and whether biopsies were reviewed by a GI expert pathologist, were also recorded. The number of biopsies taken was compared to the number expected to be taken given the extent of metaplastic change. Results: 59 patients met criteria for inclusion in the study. Of these, over 80% had reflux symptoms. Over 50% of endoscopy reports did not provide a description of mucosal appearance, nor BE length. Endoscopic landmarks were not reported in nearly 56% of cases. Over 60% of cases did not have C&M criteria reported. In nearly one quarter of cases, too few biopsies were taken. Even more concerning was the upgraded diagnosis of almost 25% of patients. Two of these cases were upgraded to adenocarcinoma. Conclusion: In our study, endoscopic quality indicators in BE were not met in patients refered to an endoscopic ablation program. There was significant inter-operator variability. In the era of endoscopic ablation, proper measurement and endoscopic description are required metrics. As well, proper pathological review is essential in the management of patients with BE. This study highlights that further education is required for endoscopists in describing BE.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".