Background and study aims: Hiatal hernia, Barrett’s esophagus and erosive esophagitis are defined and classified
by measuring their length during endoscopy. The primary aim of our study was to evaluate
the accuracy of length measurement of esophageal lesions with the conventional gastroscope
marked at 5-cm intervals, and the secondary aim was to test the performance of a modified
gastroscope marked at 1-cm intervals.
Methods: 24 senior endoscopists carried out endoscopy on a plastic mannequin. The esophagus
was randomly replaced by one of a set of seven plastic tubes, each tube having two
colored rings which were 1, 1.5, 2, 2.5, 3, 3.5 or 4 cm apart. The endoscopists were
asked to measure the distance between the mouth-guard and each of the two ”esophageal”
rings during endoscope withdrawal, with a precision of 0.5 cm. All participants endoscoped
all seven tubes blindly, first using the conventional scope and then the modified
scope.
Results: Using the conventional gastroscope, measurements were overall incorrect in 67.9 %
(95 % CI 61 - 75.1) of cases and incorrect by at least 1 cm in 21 % (95 % CI 14.8
- 27.2) of cases. These percentages were significantly reduced by using the modified
gastroscope (47.6 %, 95 % CI 40.1 - 55.2 and 7.1 %, 95 % CI 3.2 - 11.0, respectively)
(P < 0.001). Overall accuracies in measuring lengths of ≥ 2 cm and ≥ 3 cm, corresponding
to hiatal hernia and Barrett’s esophagus definitions, were 83 % and 94 % - 95 % with
the conventional and modified gastroscopes, respectively (P < 0.05).
Conclusions: Our data suggest that estimation of the length of esophageal lesions using conventional
endoscopes is inaccurate. The accuracy of measurements is significantly improved with
the use of an endoscope marked at intervals of 1 cm.
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S. D. Ladas, MD
Hepato-Gastroenterology Unit
Attikon University General Hospital
1 Rimini Street
12462 AthensGreece
Fax: + 30-210-5326422
Email: sdladas@hol.gr