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  • br Conclusions In M NBI education for


    Conclusions: In M-NBI education for endoscopists, a good learning outcome was obtained in depressed and small lesions, but a poor learning outcome was demonstrated in elevated and flat lesions. (Clinical trial registra-tion number: UMIN000008569.) (Gastrointest Endosc 2019;-:1-8.)
    Abbreviations: AUC, area under the curve; AUC/ROC, area under the receiver operating characteristic curve; cNRI, continuous net reclassifi-cation improvement; DL, demarcation line; EGC, early gastric cancer; IDI, integrated discrimination improvement; MS, microsurface; M-NBI, magnifying endoscopy with narrow-band imaging; MV, microvascular; VSCS, vessel-plus-surface classification system; WOS, white opaque substance.
    DISCLOSURE: All authors disclosed no financial relationships relevant to this 740 Y-P publication. Research support for this study (H.D.) was provided by a grant from the Japanese Foundation for Research and Promotion of Endoscopy and the Central Research Institute for Endoscopy, Fukuoka University.
    Current affiliations: Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (1), Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (2), Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan (3), Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan (4), Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan (5).
    Reprint requests: Takuji Gotoda, MD, PhD, FASGE, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Surugadai, Kanda, Chiyoda-ku, Tokyo 101-8309, Japan. Volume -, No. - : 2019 GASTROINTESTINAL ENDOSCOPY 1
    Learning effect after e-learning training in endoscopic diagnosis Ikehara et al
    Gastric cancer is the third leading cause of cancer death worldwide.1 Gastroscopy is the most sensitive method of early detection of gastric cancer.2 However, distinguishing cancerous from noncancerous mucosa using conventional white-light imaging is sometimes diffi-cult. Magnifying endoscopy with narrow-band imaging (M-NBI) was developed as an image-enhanced endoscopic technique.3,4 For M-NBI diagnosis of early gastric cancer (EGC), the vessel-plus-surface classification system (VSCS) has been prospectively proven to be useful in dis-tinguishing between EGC and noncancer lesions.5,6 In addition, the accuracy and specificity of M-NBI in identi-fying small, depressed gastric mucosal cancers were greater than those of conventional white-light imaging in a prospective randomized controlled trial.7
    We have previously developed an e-learning system to teach endoscopic diagnostic process for EGC using M-NBI based on the VSCS and proven its efficacy in improving the diagnostic performance for EGC in a multi-center randomized controlled trial.8 The main result of this study demonstrated that our e-learning system significantly improved the diagnostic ability for gastric M-NBI images in endoscopists who joined this study. The changes in accuracy in tests 1 and 2 were significantly higher in the e-learning group than in the non–e-learning group (D7.4 points vs D0.14 points, P < .001). Endoscopists can access this e-learning system through a website to learn about M-NBI and the VSCS anywhere and anytime.
    However, in our prior randomized controlled trial of the e-learning system, we did not assess whether the learning effect depends on the characteristics of the gastric lesion. The aim of this study was to clarify the difference in learning effect in each characteristic of gastric lesions in the randomized controlled trial participants.
    This study was a post hoc analysis of a multicenter ran-domized controlled trial.8 The study was conducted in line with the Consolidated Standards of Reporting Trials statement9 and the Declaration of Helsinki.10 The study protocol was approved by the institutional review board of Ishikawa Prefectural Central Hospital, Japan, and written informed consent was obtained from all participating endoscopists. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry (number UMIN000008569).
    A detailed description of the previous study’s methods is described elsewhere.8 The study flow is shown in Figure 1. We recruited endoscopists as participants from all over Japan between November 2013 and August 2014. A total of 391 endoscopists learned the VSCS from the e-learning system on the website and completed 3 diagnostic tests.8 In this post hoc analysis, participants who had a high accuracy rate ( 80%) in test 1 were
    excluded from the study because Essential gene do not have to be further educated on the subject. Finally, 365 participants were assessed in this study.