, Volume 16, Issue 1, pp 71–76 | Cite as

Inter-institutional variations regarding Barrett’s esophagus diagnosis

  • Norihisa IshimuraEmail author
  • Mika Yuki
  • Takafumi Yuki
  • Yoshinori Komazawa
  • Yoshinori Kushiyama
  • Hirofumi Fujishiro
  • Shunji Ishihara
  • Yoshikazu Kinoshita
Original Article



Barrett’s esophagus (BE) is a known precursor for development of esophageal adenocarcinoma and surveillance of affected patients is necessary when cancer progression risk is considered to be high. However, the accuracy of BE diagnosis may not be homogenous among institutions with endoscopy units. We investigated inter-institutional variability by examining the accuracy of endoscopic diagnosis of BE at 4 different hospitals.


The accuracy of BE diagnosis at the 4 hospitals was retrospectively reviewed by 6 expert endoscopists, who independently reviewed endoscopic images of approximately 500 consecutive patients examined at each hospital without information regarding the diagnosis by the on-site endoscopists. When the expert reviewers made different diagnosis, a final diagnosis was made by consensus. That was then compared with the diagnosis of the attending endoscopists at each hospital and their concordance was calculated separately for each endoscopy unit. In addition, the relationship between diagnostic accuracy and endoscopic experience was assessed.


The prevalence of BE diagnosis by the on-site endoscopists was not homogenous and varied widely (17.2–96.8%). In 1 hospital, over-diagnosis was the cause of dissimilarity, while under-diagnosis was the cause in two hospitals. Diagnostic accuracy by the attending endoscopists in all 4 hospitals ranged from 44.6 to 83.1% (P < 0.05). There was no significant association between diagnostic accuracy and endoscopic experience or board licensing status of the on-site endoscopists.


Diagnostic accuracy for BE was not homogenous among 4 hospitals, and problems related to over- and under-diagnosis should be considered.


Barrett’s esophagus Endoscopic diagnosis Diagnostic variation 



The authors thank Ms. Keiko Masuzaki and Ms. Rika Tohma for the excellent technical assistance.

Compliance with ethical standards

Ethical statement

The present study was performed at the Shimane University Hospital in accordance with the Declaration of Helsinki and the protocol was approved by the ethics committee of the Shimane, University School of Medicine.

Conflict of interest

The authors declare no conflict of interests for this article.


  1. 1.
    Katanoda K, Hori M, Matsuda T, et al. An updated report on the trends in cancer incidence and mortality in Japan, 1958–2013. Jpn J Clin Oncol. 2015;45:390–401.CrossRefGoogle Scholar
  2. 2.
    Xie SH, Lagergren J. Time trends in the incidence of oesophageal cancer in Asia: variations across populations and histological types. Cancer Epidemiol. 2016;44:71–6.CrossRefGoogle Scholar
  3. 3.
    Arnold M, Soerjomataram I, Ferlay J, et al. Global incidence of oesophageal cancer by histological subtype in 2012. Gut. 2015;64:381–7.CrossRefGoogle Scholar
  4. 4.
    Japanese Society of Esophageal Diseases. Comprehensive registry of esophageal cancer in Japan, 1999. Esophagus. 2005;2:43–69.CrossRefGoogle Scholar
  5. 5.
    Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2010. Esophagus. 2017;14:189–214.CrossRefGoogle Scholar
  6. 6.
    de Jonge PJ, van Blankenstein M, Grady WM, et al. Barrett’s oesophagus: epidemiology, cancer risk and implications for management. Gut. 2014;63:191–202.CrossRefGoogle Scholar
  7. 7.
    Sami SS, Ragunath K, Iyer PG. Screening for Barrett’s esophagus and esophageal adenocarcinoma: rationale, recent progress, challenges, and future directions. Clin Gastroenterol Hepatol. 2015;13:623–34.CrossRefGoogle Scholar
  8. 8.
    Ishimura N, Amano Y, Kinoshita Y. Endoscopic definition of esophagogastric junction for diagnosis of Barrett’s esophagus: importance of systematic education and training. Dig Endosc. 2009;21:213–8.CrossRefGoogle Scholar
  9. 9.
    Ishimura N, Amano Y, Sollano J, et al. Questionnaire-based survey conducted in 2011 concerning endoscopic management of barrett’s esophagus in East Asian countries. Digestion. 2012;86:136–46.CrossRefGoogle Scholar
  10. 10.
    Scholvinck D, Goto O, Seldenrijk CA, et al. Detection of palisade vessels as a landmark for Barrett’s esophagus in a Western population. J Gastroenterol. 2016;51:682–90.CrossRefGoogle Scholar
  11. 11.
    Amano Y, Ishimura N, Furuta K, et al. Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc. 2006;64:206–11.CrossRefGoogle Scholar
  12. 12.
    Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–9.CrossRefGoogle Scholar
  13. 13.
    Pohl H, Pech O, Arash H, et al. Length of Barrett’s oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut. 2016;65:196–201.CrossRefGoogle Scholar
  14. 14.
    Anaparthy R, Gaddam S, Kanakadandi V, et al. Association between length of barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol. 2013;11:1430–6.CrossRefGoogle Scholar
  15. 15.
    Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.CrossRefGoogle Scholar
  16. 16.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  17. 17.
    Japan Esocphageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRefGoogle Scholar
  18. 18.
    Amano Y, Kinoshita Y. Barrett esophagus: perspectives on its diagnosis and management in asian populations. Gastroenterol Hepatol (N Y). 2008;4:45–53.Google Scholar
  19. 19.
    Sugimoto H, Kawai T, Naito S, et al. Surveillance of short-segment Barrett’s esophagus using ultrathin transnasal endoscopy. J Gastroenterol Hepatol. 2015;30(Suppl 1):41–5.CrossRefGoogle Scholar
  20. 20.
    Ganz RA, Allen JI, Leon S, et al. Barrett’s esophagus is frequently overdiagnosed in clinical practice: results of the Barrett’s Esophagus Endoscopic Revision (BEER) study. Gastrointest Endosc. 2014;79:565–73.CrossRefGoogle Scholar
  21. 21.
    Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–31.CrossRefGoogle Scholar
  22. 22.
    Runge TM, Dellon ES. Do we know what causes eosinophilic esophagitis? A mechanistic update. Curr Gastroenterol Rep. 2015;17:33.CrossRefGoogle Scholar
  23. 23.
    Aida J, Vieth M, Ell C, et al. Palisade vessels as a new histologic marker of esophageal origin in ER specimens from columnar-lined esophagus. Am J Surg Pathol. 2011;35:1140–5.CrossRefGoogle Scholar
  24. 24.
    Kumagai Y, Yagi M, Aida J, et al. Detailed features of palisade vessels as a marker of the esophageal mucosa revealed by magnifying endoscopy with narrow band imaging. Dis Esophagus. 2012;25:484–90.CrossRefGoogle Scholar
  25. 25.
    El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65:1252–60.CrossRefGoogle Scholar
  26. 26.
    Qiao Y, Hyder A, Bae SJ, et al. Surveillance in patients with Barrett’s esophagus for early detection of esophageal adenocarcinoma: a systematic review and meta-analysis. Clin Transl Gastroenterol. 2015;6:e131.CrossRefGoogle Scholar
  27. 27.
    Kestens C, Offerhaus GJ, van Baal JW, et al. Patients With Barrett’s esophagus and persistent low-grade dysplasia have an increased risk for high-grade dysplasia and cancer. Clin Gastroenterol Hepatol. 2016;14:956–62.CrossRefGoogle Scholar
  28. 28.
    Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut. 2013;62:15–21.CrossRefGoogle Scholar
  29. 29.
    Takubo K, Aida J, Naomoto Y, et al. Cardiac rather than intestinal-type background in endoscopic resection specimens of minute Barrett adenocarcinoma. Hum Pathol. 2009;40:65–74.CrossRefGoogle Scholar
  30. 30.
    Chang J, Fasanella K, Chennat J, et al. Prevalence of esophageal neoplasia in short-segment versus long-segment Barrett’s esophagus. Esophagus. 2016;13:151–5.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyShimane University School of MedicineIzumoJapan
  2. 2.Department of Internal MedicineIzumo City General Medical CenterIzumoJapan
  3. 3.Division of GastroenterologyMatsue Red Cross HospitalMatsueJapan
  4. 4.Division of GastroenterologyShimane Prefectural Central HospitalIzumoJapan

Personalised recommendations