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

evaluated interrater reliability by having a separate pathologist (blinded to the results of the first pathologist) review pathology slides from 616 patients. In addition, the referral pathologist conducted a blind rereview of 44 slides he had previously reviewed during the three year duration of the study.

Results

After medical record review, an assignment of ''Barrett's esophagus'' was confirmed in 1,530 (61.9 percent) and rejected in 848 (34.3 percent), and there were insufficient data in 92 (3.7 percent) of all subjects. A diagnosis was confirmed among 437 of 798 patients (54.8 percent) with a SNOMED diagnosis alone, 153 of 571 patients (26.8 percent) with an ICD diagnosis alone, and 940 of 1,101 patients (85.4 percent) who had both a SNOMED and an ICD diagnosis of Barrett's esophagus. If any ICD diagnosis was used (regardless of whether a SNOMED diagnosis was assigned), a diagnosis was confirmed among 1,093 of 1,672 patients (65.4 percent).

An initial pathologic diagnosis of esophageal intestinal metaplasia in this population was highly likely to be confirmed with a slide review from a second referral pathologist. Therefore, a second slide review provided relatively little additional value. Patients identified with either an ICD or a SNOMED code for Barrett's esophagus provided the greatest sensitivity for detecting patients with a Barrett's esophagus diagnosis within a population; however, this was only moderately accurate. Identifying patients with both ICD and SNOMED codes correctly classified approximately 85.4 percent of subjects compared with medical record review, but this method only detected 61 percent of all patients with Barrett's esophagus. The authors emphasized that the proportion of patients confirmed to have Barrett's esophagus likely represents the minimum number given the strict criteria used.

Researchers concluded that electronic coding alone overestimates the prevalence of Barrett's esophagus, and
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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