Evaluation of an e-learning system for diagnosis of gastric lesions using magnifying narrow-band imaging: a multicenter randomized controlled study
Authors: Nakanishi Hiroyoshi , Doyama Hisashi , Ishikawa Hideki , Uedo Noriya , Gotoda Takuji , Kato Mototsugu , Nagao Shigeaki , Nagami Yasuaki , Aoyagi Hiroyuki , Imagawa Atsushi , Kodaira Junichi , Mitsui Shinya , Kobayashi Nozomu , Muto Manabu , Takatori Hajime , Abe Takashi , Tsujii Masahiko , Watari Jiro , Ishiyama Shuhei , Oda Ichiro , Ono Hiroyuki , Kaneko Kazuhiro , Yokoi Chizu , Ueo Tetsuya , Uchita Kunihisa , Matsumoto Kenshi , Kanesaka Takashi , Morita Yoshinori , Katsuki Shinichi , Nishikawa Jun , Inamura Katsuhisa , Kinjo Tetsu , Yamamoto Katsumi , Yoshimura Daisuke , Araki Hiroshi , Kashida Hiroshi , Hosokawa Ayumu , Mori Hirohito , Yamashita Haruhiro , Motohashi Osamu , Kobayashi Kazuhiko , Hirayama Michiaki , Kobayashi Hiroyuki , Endo Masaki , Yamano Hiroo , Murakami Kazunari , Koike Tomoyuki , Hirasawa Kingo , Miyaoka Youichi , Hamamoto Hidetaka , Hikichi Takuto , Hanabata Norihiro , Shimoda Ryo , Hori Shinichiro , Sato Tadashi , Kodashima Shinya , Okada Hiroyuki , Mannami Tomohiko , Yamamoto Shojiro , Niwa Yasumasa , Yashima Kazuo , Tanabe Satoshi , Satoh Hiro , Sasaki Fumisato , Yamazato Tetsuro , Ikeda Yoshiou , Nishisaki Hogara , Nakagawa Masahiro , Matsuda Akio , Tamura Fumio , Nishiyama Hitoshi , Arita Keiko , Kawasaki Keisuke , Hoppo Kazushige , Oka Masashi , Ishihara Shinichi , Mukasa Michita , Minamino Hiroaki , Yao Kenshi 
Published: June 2017

Abstract
Background and study aim Magnifying narrow-band imaging (M-NBI) is useful for the accurate diagnosis of early gastric cancer (EGC). However, acquiring skill at M-NBI diagnosis takes substantial effort. An Internet-based e-learning system to teach endoscopic diagnosis of EGC using M-NBI has been developed. This study evaluated its effectiveness.
Participants and methods This study was designed as a multicenter randomized controlled trial. We recruited endoscopists as participants from all over Japan. After completing Test 1, which consisted of M-NBI images of 40 gastric lesions, participants were randomly assigned to the e-learning or non-e-learning groups. Only the e-learning group was allowed to access the e-learning system. After the e-learning period, both groups received Test 2. The analysis set was participants who scored < 80 % accuracy on Test 1. The primary end point was the difference in accuracy between Test 1 and Test 2 for the two groups.
Results A total of 395 participants from 77 institutions completed Test 1 (198 in the e-learning group and 197 in the non-e-learning group). After the e-learning period, all 395 completed Test 2. The analysis sets were e-learning group: n = 184; and non-e-learning group: n = 184. The mean Test 1 score was 59.9 % for the e-learning group and 61.7 % for the non-e-learning group. The change in accuracy in Test 2 was significantly higher in the e-learning group than in the non-e-learning group (7.4 points vs. 0.14 points, respectively; P < 0.001).
Conclusion This study clearly demonstrated the efficacy of the e-learning system in improving practitioners’ capabilities to diagnose EGC using M-NBI.Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000008569).