A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program

Abstract

Introduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool. Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 – 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones. Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (P < 0.001). Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp.

Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

“…Recently, the BASIC (BLI Adenoma Serrated International Classification) classification for BLI was externally validated in clinical practice [53,54]. Other proposed classifications, such as ICE (i-scan classification for endoscopic diagnosis using i-scan OE), SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy for i-scan OE and NBI), and CONECCT (COlorectal Neoplasia Endoscopic Classification to Choose the Treatment), have not been fully validated [55,56,60].…”

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

“…In any case, optical diagnosis of lympho-vascular invasion, tumor budding and poor differentiation, which were the only reason for classifying LPs as high-risk T1 CRCs in 16% of cases, seems impossible. The usefulness of the CONECCT table, a simple, mixed diagnostic and therapeutic classification system designed to improve histological prediction and choose the best therapeutic strategy for each lesion subtype, remains to be demonstrated (28).…”

“…In any case, optical diagnosis of lymphovascular invasion, tumor budding and poor differentiation, which were the only reason for classifying LPs as high-risk T1 CRCs in 16% of cases, seems impossible. The usefulness of the CONECCT table, a simple, mixed diagnostic and therapeutic classification system designed to improve histological prediction and choose the best therapeutic strategy for each lesion subtype, remains to be demonstrated(28).ESD was marginally used in our community-based study (3.7% of non-pedunculated LPs) and mostly misused (95.5% for benign LPs). Of 22 patients treated by ESD, only one (4.5%) benefited from this technique that allowed surgery to be avoided.…”

Overutilization of surgery for the resection of benign colorectal lesions: the hidden reasons for inappropriate referral!

“…It could be argued that no classification is 100 % accurate, and its false-negative/-positive results could lead to under-treatment/overtreatment. However, while it may be difficult to identify a deeply invasive malignant area within a lesion (i. e., NICE 3 sensitivity of only 63 % [5]), it is extremely rare to misdiagnose a deeply invasive lesion as a noninvasive benign lesion (NICE 3 specificity > 96 % [6]) even by non-expert gastroenterologists [7]. What are the main barriers preventing the replacement of size with optical diagnosis?…”