Endoscopic assessment of the “Z-line” (squamocolumnar junction) appearance: Reproducibility of the ZAP classification among endoscopists

Wallner, Bengt; Sylvan, Anders; Janunger, Karl-Gunnar

doi:10.1067/mge.2002.119876

Cited by 32 publications

(28 citation statements)

References 22 publications

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“…Many studies of physician interobserver agreement demonstrate a wide range of deviation (6)(7)(8)(9). The main predictive factors for agreement were observer experience and type of findings.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5)(6)(7)(8)(9), as well as between gastroenterologists and nurses (10)(11)(12)(13). Most of the differences were associated with level of experience and borderline results (8,9). There was a high level of agreement for clear and well-known findings, such as polyps and ulcers, and a low level for indeterminate lesions such as irregular "Z-lines."…”

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confidence: 97%

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Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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Capsule endoscopy (CE) has been recommended as the method of choice for diagnostic endoscopy of the small bowel. An experienced nurse, after proper training, may contribute to the endoscopy procedures as previously described for sigmoidoscopy. The aim of this study was to evaluate the ability of an experienced gastroenterology nurse to prepare CE records for physician interpretation, by detecting abnormal thumbnails. A prospective, observational design was used. Fifty CE videos were preread by a specially trained gastroenterology nurse who thumbnailed the abnormalities detected for interpretation by the gastroenterologist. The nurse's description of the lesions and the calculated gastric and bowel transit times were compared to the interpretation of the videos made directly by the gastroenterologist (gold standard). The primary end point of the study was the quality of the nurse's pathology findings; the secondary end point was the cost effectiveness of this practice. There was complete agreement between the nurse and gastroenterologist for all 12 cases interpreted as normal by the gastroenterologist. In the remaining 38 cases, the nurse created 130 thumbnail selections and the physician, 99. Complete interobserver agreement was achieved for 93 of the 96 lesions categorized as "significant" by the physician (96.9%). After all relevant variables were taken into account, this approach saved $324 per CE examination. The use of nurse practitioner to preread CE videos and prepare thumbnail selections for further assessment by the gastroenterologist appears to be safe, reliable, and cost effective.KEY WORDS: M2A; capsule endoscopy; endoscopy; enteroscopy; small bowel.Recent studies recommending video capsule endoscopy (CE) as the method of choice for small bowel diagnostic endoscopy have led to its growing application in medical practice (1-4). At present, however, the extensive use of CE is limited by its high cost. Furthermore, as with any new technique, its proper implementation involves experience and a learning curve to minimize errors in interpretation. Previous studies of conventional endoscopy demonstrated variability in findings and interpretations among gastroenterologists (5-9), as well as between gastroenterologists and nurses (10-13). Most of the differences were associated with level of experience and borderline results (8, 9). There was a high level of agreement for clear and well-known findings, such as polyps and ulcers, and a low level for indeterminate lesions such as irregular "Z-lines." Levinthal et al. (12) in a small study of 20 capsule videos, found that goal results were achieved when the capsule results were first read by a trained gastroenterology nurse who demarcated the areas of suspected pathology for further assessment by the physician. This strategy saved time and money without compromising the quality of the examination. It is supported by a wealth of evidence in the literature that gastroenterology nurses can efficiently interpret other types of endoscopic data (10-12).The aim of the...

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Section: Discussionmentioning

confidence: 99%

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confidence: 97%

Capsule Endoscopy Examination—Preliminary Review by a Nurse

Niv

2005

Dig Dis Sci

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“…The proposed CM, or Prague, classification of Barrett's esophagus, which measures the highest extent of metaplasia, as well as the extent of circular metaplasia, also rely on the ability to accurately define the GEJ at endoscopy, because it uses the GEJ as a reference point [7]. On the other hand, the ZAP-classification, which does not measure the extent of Barrett's esophagus, but merely defines the appearance of the Z-line, does not depend on the definition of the GEJ, and it has been proven highly reproducible [14,15]. The endoscopic definition most often used for the GEJ is the proximal margin of the longitudinal folds of the stomach.…”

Section: Discussionmentioning

confidence: 99%

Endoscopically defined gastroesophageal junction coincides with the anatomical gastroesophageal junction

Wallner

2008

Surg Endosc

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“…After evaluation of the esophagus and GEJ, biopsy for suspected BE was performed when the squamocolumnar junction (SCJ) was located proximal to the anatomic GEJ in patients with ZAP classification grade I-III. 25 When indicated, biopsies for BE were obtained every 2 cm in four quadrants from the anatomic GEJ to the SCJ. Pathologic determination of BE was performed by a single pathologist using established diagnostic criteria.…”

Section: Small-caliber Endoscopymentioning

confidence: 99%