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Study examines reliability of clinical and pathological diagnoses of Barrett's esophagus
Date:5/14/2009

ly to choose their own diagnosis code before they receive pathology results. Secondly, hospital-based coders also report "rule out" diagnoses and are thus likely to over-code Barrett's esophagus when the physician includes the possibility of Barrett's esophagus in the visual description.

Barrett's esophagus is a condition where the lining of the esophagus changes due to chronic inflammation, generally from gastroesophageal reflux disease (GERD). Definitive diagnosis requires a biopsy, taken at upper endoscopy, demonstrating replacement of the normal cell lining with one more like the cell lining of the small intestine. This is also known as intestinal metaplasia (IM). Barrett's esophagus itself has no specific symptoms, but this change can increase the risk of esophageal adenocarcinoma (a type of esophageal cancer). Barrett's esophagus can be readily detected during an upper endoscopy but must be confirmed by biopsies (tissue samples that are examined by a pathologist). The intent is to diagnose this condition, treat it medically, and follow it over time to detect changes indicating that a cancer may be developing.

"We found that a pathologic diagnosis of esophageal intestinal metaplasia is highly likely to be reproduced by a separate review of the slides. In addition, the modest intraobserver variation seen for a single pathologist suggests that a proportion of the discordance for pathology reviews between different pathologists may result from somewhat random misclassification rather than from an incorrect reading by the original pathologist," said study lead author Douglas A. Corley, MD, PhD, Division of Research, Kaiser Permanente. "In contrast, a coded diagnosis of Barrett's esophagus was confirmed by record review only 61.9 percent of the time, a number that is likely too low by itself for either clinical or research uses without supplemental manual verification. However, among the substantial proportion of patients who had both a SNOME
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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