Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps

Ignjatovic, Ana; Thomas-Gibson, Siwan; East, James E.; Haycock, Adam; Bassett, Paul; Bhandari, Pradeep; Man, Ripple; Suzuki, Noriko; Saunders, Brian P.

doi:10.1016/j.gie.2010.09.021

Cited by 102 publications

(103 citation statements)

References 18 publications

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“…Several studies have evaluated training packages that were developed to train endoscopists in the use of NBI. 72,94,141,142 For example, Ignjatovic and colleagues 141 conducted a prospective education study of a computer-based training module in 21 individuals (novices, trainees and experienced gastroenterologists) with varying colonoscopy experience in the UK. There was significant improvement in the accuracy in characterisation of polyps after the training.…”

Section: Training Costsmentioning

confidence: 99%

“…There was significant improvement in the accuracy in characterisation of polyps after the training. Ignjatovic and colleagues 141 commented that, although the NBI learning curve 72 showed that the performance of endoscopists could be sustained over time by repeating the training module at the mid-point of the study. Meads and colleagues 142 suggest that ongoing training and assessment is necessary to sustain performance.…”

Section: Training Costsmentioning

confidence: 99%

See 1 more Smart Citation

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

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BackgroundCurrent clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification.DesignSystematic review and economic analysis.ParticipantsPeople undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer.InterventionsNBI, FICE and i-scan.Main outcome measuresDiagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology.Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost–utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research’s bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy.ResultsThirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan.LimitationsLimited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps.ConclusionsVCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training.Future workFuture research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality.Study registrationThis study is registered as PROSPERO CRD42016037767.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Training Costsmentioning

confidence: 99%

Section: Training Costsmentioning

confidence: 99%

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Picot

Rose

Cooper

et al. 2017

Health Technol Assess

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“…(20). Training programs including ex vivo evaluation of photographs of colonic polyps with known histology, real-time optical diagnosis of polyps during NBI colonoscopy, and comparison with histopathologic results, as well as computerized training modules, represent the methods proposed to improve diagnostic accuracy [25,26].…”

Section: Characterization Of Colonic Lesionsmentioning

confidence: 99%

The Usefulness Of Narrow Band Imaging Endoscopy For The Real Time Characterization Of Colonic Lesions

Boeriu

Pascarenco

Brusnic

et al. 2016

Acta Medica Marisiensis

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Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria. IntroductionThe development of advanced endoscopic techniques such as narrow band imaging endoscopy, with or without magnification, represents an important step in the improvement of characterization of colonic lesions by predicting underlying histology. This creates the possibility to adopt new strategies regarding therapy and surveillance in clinical practice. The potential benefits of the real time estimation of a polyp's histology during NBI endoscopy, so called "optical biopsy", are related to potentially decreasing total costs of colonoscopy by eliminating unnecessary biopsies and polypectomies. Recent reports have shown promising results in this field, but controversies remain. Concerns center upon a lack of standardization among different classification systems, variable inter-observer agreement, and lagging clinical acceptance.The aim of this paper is to assess the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses published in the last eight years in the PubMed and MEDLINE databases for the following search terms: narrow band imaging endoscopy, colonic polyps, and colorectal neoplasia.

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“…Fortunately, NBI interpretation of histology can be easily learned. Several studies have shown significant improvements in diagnostic accuracy and in interobserver agreement after following a computer-based training module [75] or a short teaching session [76].…”

Section: Prediction Of Histology Of Diminutive Polypsmentioning

confidence: 99%

In vivo Optical Diagnosis of Polyp Histology: Can We Omit Pathological Examination of Diminutive Polyps?

Bustamante-Balén¹

2013

Colonoscopy and Colorectal Cancer Screening - Future Directions

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Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps

Cited by 102 publications

References 18 publications

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

The Usefulness Of Narrow Band Imaging Endoscopy For The Real Time Characterization Of Colonic Lesions

In vivo Optical Diagnosis of Polyp Histology: Can We Omit Pathological Examination of Diminutive Polyps?

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