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An interactive web-based educational tool improves detection and delineation of Barrett’s esophagus related neoplasia

Bergman, J.J.; de Groof, A.J.; Pech, O.; Ragunath, K.; Armstrong, D.; Mostafavi, N.; Lundell, L.; Dent, J.; Vieth, M.; Tytgat, G.N.; Sharma, P.


J.J. Bergman

A.J. de Groof

O. Pech

K. Ragunath

D. Armstrong

N. Mostafavi

L. Lundell

J. Dent

M. Vieth

G.N. Tytgat

P. Sharma


Background & Aims: Endoscopic detection of early Barrett’s esophagus-related neoplasia (BORN) is a challenge. We aimed to develop a web-based teaching tool for improving detection and delineation of BORN.

Methods: We made high-definition digital videos during endoscopies of patients with BORN and non-dysplastic Barrett’s esophagus (NDBE). Three experts superimposed their delineations of BORN lesions on the videos using special tools. In phase 1, 68 general endoscopists from 4 countries assessed 4 batches of 20 videos. After each batch, mandatory feedback compared assessors interpretations with those from experts . These data informed selection of 25 videos for the phase 2 module, which was completed by 121 new assessors from 5 countries. A 5-video test batch was completed before and after scoring of the four 5-video training batches. Mandatory feedback was as in phase 1. Outcome measures were scores for detection, delineation, agreement delineation, and relative delineation of BORN.

Results: A linear mixed-effect model showed significant sequential improvement for all 4 outcomes over successive training batches in both phases. In phase 2, median detection rates of BORN in the test batch increased by 30% (P [less than].001) after training. From baseline to the end of the study, there were relative increases in scores of 46% for detection, 129% for delineation, 105% for agreement delineation, and 106% for relative delineation (all P [less than].001). Scores improved independent of assessors’ country of origin or level of endoscopic experience.


Bergman, J., de Groof, A., Pech, O., Ragunath, K., Armstrong, D., Mostafavi, N., …Sharma, P. (2019). An interactive web-based educational tool improves detection and delineation of Barrett’s esophagus related neoplasia. Gastroenterology, 156(5), 1299-1308.e3.

Journal Article Type Article
Acceptance Date Dec 22, 2018
Online Publication Date Jan 2, 2019
Publication Date Jan 2, 2019
Deposit Date Jan 10, 2019
Publicly Available Date Jan 3, 2020
Journal Gastroenterology
Electronic ISSN 1528-0012
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 156
Issue 5
Pages 1299-1308.e3
Keywords BORN Project, Esophageal adenocarcinoma, Barrett Esophagus, Endoscopy
Public URL
Publisher URL
Additional Information Corresponding author:
J.J. Bergman, MD PhD
Professor of Gastrointestinal Endoscopy
Director of Endoscopy
Academic Medical Center Amsterdam
Meibergdreef 9
1105 AZ Amsterdam
The Netherlands
Phone number: +31 (0)20 5663556
Fax number: +31 (0)20 6917033


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