Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 14, 2008; 14(46): 7086-7092
Published online Dec 14, 2008. doi: 10.3748/wjg.14.7086
Web-based system for training and dissemination of a magnification chromoendoscopy classification
Mário Jorge Dinis-Ribeiro, Ricardo Cruz Correia, Cristina Santos, Sónia Fernandes, Ernesto Palhares, Rui Almeida Silva, Pedro Amaro, Miguel Areia, Altamiro Costa-Pereira, Luis Moreira-Dias
Mário Jorge Dinis-Ribeiro, Rui Almeida Silva, Luis Moreira-Dias, Gastroenterology Department, Portuguese Oncology Institute, Porto 4200-072, Portugal
Mário Jorge Dinis-Ribeiro, Ricardo Cruz Correia, Cristina Santos, Sónia Fernandes, Ernesto Palhares, Altamiro Costa-Pereira, Center for Research in Information Systems and Health Technologies (CINTESIS)/Department of Biostatistics and Medical Informatics, Porto Faculty of Medicine, Porto 4200-319, Portugal
Pedro Amaro, Miguel Areia, Gastroenterology Department, Coimbra University Hospital, Coimbra 3000-075, Portugal
Author contributions: Dinis-Ribeiro M was responsible for the design, implementation, data analysis and writing of the manuscript; Correia R, Fernandes S and Palhares E developed and implemented the web-system, its improvement and critically reviewed the manuscript; Santos C and Costa-Pereira A participated in the design of study and data analysis; Silva RA, Amaro P and Areia M participated in the study and critically reviewed the manuscript for discussion; Moreira-Dias L participated in the design, implementation and discussion of results.
Supported by Sociedade Portuguesa de Endoscopia Digestiva (Research Grant 2002) and the European Society for Gastrointestinal Endoscopy
Correspondence to: Mário Jorge Dinis-Ribeiro, MD, PhD, Gastroenterology Department, Portuguese Oncology Institute, Rua Dr. Bernardino de Almeida, Porto 4200-072, Portugal.
Telephone: + 351-22-5084000-3348 Fax: +351-22-5084055
Received: July 28, 2008
Revised: September 9, 2008
Accepted: September 16, 2008
Published online: December 14, 2008

AIM: To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy (MC).

METHODS: As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an “autorun” file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer.

RESULTS: For classification in 3 groups, both intra- [Cohen’s kappa (κ) = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st (moderate) to 6th observation (κ = 0.94). Also, agreement with reference increased in the last observations (0.90, 1.00 and 1.00, for observers A, B and C, respectively). Validity of 100% was obtained by all observers at their 4th observation. When a 4th (sub)group was considered, inter-observer agreement was almost perfect (κ = 0.92) at 6th observation. The relation with reference clearly improved into κ (0.93-1.00) and sensitivity (75%-100%) at their 6th observations.

CONCLUSION: This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.

Keywords: Magnification, Chromoendoscopy, Reproducibility, Learning curve