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Endoscopy 2008; 40(6): 457-463
DOI: 10.1055/s-2007-995741
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Narrow-band imaging with magnification in Barrett’s esophagus: validation of a simplified grading system of mucosal morphology patterns against histology

R.  Singh1 , G.  K.  Anagnostopoulos1 , K.  Yao1 , H.  Karageorgiou1 , P.  J.  Fortun1 , A.  Shonde1 , K.  Garsed1 , P.  V.  Kaye2 , C.  J.  Hawkey1 , K.  Ragunath1
  • 1Wolfson Digestive Diseases Centre, Queen’s Medical Centre, Nottingham, UK
  • 2Department of Histopathology, Queen’s Medical Centre, Nottingham, UK
Further Information

Publication History

submitted 20 November 2007

accepted after revision 4 February 2008

Publication Date:
06 May 2008 (online)

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Commentaire de travail de R. Singh et al., pp. 457Endoscopy 2008; 40(06): 544-544
DOI: 10.1055/s-0032-1306838

Background and study aims: Validation of a simplified classification of mucosal morphology in prediction of histology in Barrett’s esophagus using narrow-band imaging with magnification (NBI-Z) and assessing its reproducibility by endoscopists experienced in the use of NBI (NBI-experts) and by endoscopists who were new to NBI (non-NBI-experts).

Patients and methods: In a prospective cohort study of 109 patients with Barrett’s esophagus at a single tertiary referral center, mucosal patterns visualized in Barrett’s esophagus on NBI-Z were classified into four easily distinguishable types: A, round pits with regular microvasculature; B, villous/ridge pits with regular microvasculature; C, absent pits with regular microvasculature; D, distorted pits with irregular microvasculature. The NBI-Z grading was compared with the final histopathological diagnosis, and positive (PPV) and negative predictive values (NPV) were calculated. The reproducibility of the grading was then assessed by NBI-expert and non-NBI-expert endoscopists, and interobserver and intraobserver agreement were calculated using κ statistics.

Results: Per-biopsy analysis: In 903 out of 1021 distinct areas (87.9 %) the NBI-Z grading corresponded to the histological diagnosis. Per-patient analysis: The PPV and NPV for type A pattern (columnar mucosa without intestinal metaplasia) were 100 % and 97 % respectively; for types B and C (intestinal metaplasia) they were 88 % and 91 % respectively, and for type D (high-grade dysplasia) 81 % and 99 % respectively. Inter- and intraobserver agreement: The mean κ values in assessing the various patterns were 0.71 and 0.87 in the non-expert group; 0.78 and 0.91 in the expert group.

Conclusions: This study has validated a simplified classification of the various morphologic patterns visualized in Barrett’s esophagus and confirmed its reproducibility when used by NBI-expert and non-NBI-expert endoscopists.

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K. Ragunath, MD, FRCP 

Wolfson Digestive Diseases Centre

Queen’s Medical Centre Campus

Nottingham University Hospitals NHS Trust

Nottingham

NG7 2UH

UK

Fax: +44-115-9422232

Email: K.Ragunath@nottingham.ac.uk

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