Accuracy in the diagnosis of short-segment Barrett's esophagus: The role of endoscopic experience

Background: The diagnosis of Barrett's esophagus is based on histologic demonstration of specialized intestinal metaplasia. Experience may be important in the endoscopic recognition of Barrett's esophagus, including in regard to appropriate procurement of biopsy specimens. The aim of this study was to assess factors that may influence accuracy in the diagnosis of short-segment Barrett's esophagus (SSB). Methods: Endoscopy reports pertaining to procedures performed over a 1-year period that included esophageal biopsies because of suspected intestinal metaplasia were reviewed. Barrett's epithelium involving less than 2 cm of the distal esophagus was considered SSB; greater than 2 cm was considered long-segment (LSB). Endoscopists were regarded as "more experienced" if they had completed training more than 5 years earlier and "less experienced" if the time elapsed since the completion of training was less than 5 years. Results: More and less experienced endoscopists both obtained esophageal biopsy specimens because of suspected Barrett's esophagus at the same rate (14%). Length of suspected Barrett's epithelium was not predicted by symptoms or demographic data. Endoscopically, patients with SSB had significantly fewer (64.2% vs. 90.8%) and smaller (2.9 ± 0.1 vs. 3.5 ± 0.2 cm) hiatal hernias compared with those with LSB (p < 0.05). Suspected SSB was histologically confirmed in 38.4% (True SSB), whereas LSB was confirmed in 75% (True SSB) (p < 0.05). More experienced endoscopists were significantly more likely to obtain histologic confirmation of SSB than less experienced endoscopists (48.6% vs. 29.5%; p = 0.02, nominal significance from univariate hypothesis testing; correction for multiple testing of data removed significance at the p < 0.05 level; OR = 2.26). Conclusion: With greater experience, an endoscopist is more likely to diagnose SSB. This may be due to more accurate procurement of adequate tissue samples, which thereby results in a greater yield of histopathologic diagnoses.