Accuracy of the endoscopist in predicting histologic diagnosis of biopsies obtained during esophagogastroduodenoscopy

While endoscopic appearance may suggest certain disease processes, biopsies are often obtained to confirm or rule out these conditions. Histologic evaluation of biopsy specimens adds substantial expense to an endoscopic procedure OBJECTIVE; To prospectively evaluate the accuracy of the endoscopist in predicting histologic diagnoses in an attempt to identify conditions in the upper gastrointestinal tract that may not need histologic confirmation METHODS: A questionnaire was filled out by the endoscopist upon completion of esophagogastroduodenoscopic examinations with biopsies obtained from 7/95 through 11/95, which included the biopsy site, macroscopic appearance, and predicted histologic diagnosis of each specimen Predicted histologic diagnoses were compared with the pathology report, with sensitivity (sens), specificity (spec), positive predictive value (ppv) and negative predictive value (npv) calculated for the most commonly encountered diagnoses RESULTS: 119 biopsies were obtained from 94 patients, 44 from the esophagus, 59 from the stomach, and 16 from the proximal small bowel Overall accuracy rates were 57% in the esophagus, 39% in the stomach, and 44% in the small intestine. Predicted diagnosis # sens spec ppv npv Normal mucosa 40 32 92 68 73 Esophagitis 10 50 94 71 86 Barren's esophagus 23 78 48 62 67 H. pylon infection 10 40 74 25 85 Gastritis (non-Hp.) 29 48 68 61 56 CONCLUSIONS: 1) Accuracy of the endoscopist in predicting histologic diagnoses in the upper gastrointestinal tract is poor 2) Histologic confirmation remains an important component of endoscopy.