Effects of Training and Feedback on Accuracy of Predicting Rectosigmoid Neoplastic Lesions and Selection of Surveillance Intervals by Endoscopists Performing Optical Diagnosis of Diminutive Polyps

Vleugels, Jasper L A; Dijkgraaf, Marcel G. W.; Hazewinkel, Yark; Wanders, Linda K; Fockens, Paul; Dekker, Evelien; Becx, Marco C.; Berkel, A. M. van; Slot, W. Bruins; Cazemier, M.; Depla, A.C.T.M.; Geesing, Joost M J; Grool, T.A.; Houben, G.M.P.; Jansen, Jeroen M.; Kessels, Koen; Leerdam, Monique E. van; Lelyveld, Niels van; Mallant-Hent, RC; Marsman, Willem A.; Schnekenburger, E.; Soest, Ellert J. van; Spek, Bas W. van der; Stokkers, P.C.F.; Noorden, Jacco Tenthof van; Tuyl, Sebastiaan A.C. van; Tytgat, Kristien M. A. J.; Uiterwaal, M. Tessa; Verdonk, R.C.; Verhagen, M. A. M. T.; Vlugt, Manon van der; Voorburg, A.; Wientjes, C.A.

doi:10.1053/j.gastro.2018.01.063

Cited by 41 publications

(71 citation statements)

References 39 publications

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“…23 According to a meta-analysis, HC characterization was the most significant predictor of optical diagnostic accuracy and HC prediction was made in 77% of study polyps. 4 In previous multicenter studies of novices, the proportion of HC was 74% in the study by Patel et al 11 and 73.5% in the study by Vleugels et al 22 In this study, the proportion of HC diagnosis was similar, 72.1%. The proportion of HC in recent studies seems to be lower compared with the assumption of 84% of HC in previous cost effectiveness analyses.…”

Section: Discussionsupporting

confidence: 65%

“…The recent study, in which nonexpert endoscopists in the Dutch colonoscopy program underwent ex vivo training for WASP classification, followed by randomization into observation and feedback arms, showed similar results as the present study. 22 A randomized study design could have enhanced the reliability of our study results. Second, our study was not powered to examine individual performance to the same extent as in previous studies.…”

Section: Discussionmentioning

confidence: 92%

“…7,8 Before engaging in formal real-time optical diagnosis, it is very important to have sufficient knowledge and skills. In a recent multicenter study of 27 endoscopists by Vleugels et al, 22 the endoscopists had 3 attempts to pass the qualification test in both ex vivo and in vivo situations and they succeeded in achieving both PIVI thresholds in real-time optical diagnosis as a group. In this study, the endoscopists also underwent a sufficient real-time experience during 3 months (in vivo phase 1) after completion of ex vivo training.…”

Section: Discussionmentioning

confidence: 99%

“…Second, our study was not powered to examine individual performance to the same extent as in previous studies. 11,22 However, we tried to overcome the limitation of a group performance analysis by allocating the same number of colonoscopies to participating endoscopists during the study period. We tested the largest number of colonoscopies and polyps per endoscopist and showed a narrow range of procedures and polyps among them; 218 (IQR, 191-239) colonoscopies and 486 (IQR, 370-572) polyps.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

Bae

Lee

Kang

et al. 2019

Clinical Gastroenterology and Hepatology

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

Bae

Lee

Kang

et al. 2019

Clinical Gastroenterology and Hepatology

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“…In a study by Vleugels et al [8] endoscopists first underwent image-based interactive training followed by an image-based post-training test and finally a plenary discussion of all polyps included in the test. If the endoscopists failed the first, they had two more attempts to pass the test.…”

mentioning

confidence: 99%

Predictive Narrow-Band Imaging of Colonic Polyps: The Optics Are Good

2018

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In order to assure safe, technically successful examinations and to achieve clinically relevant outcomes, ensuring endoscopic competence is a priority for GI professional societies. When a paradigm shift occurs, as was the case with the Resect and Discard (R&D) strategy for diminutive polyps, a strategy aimed at avoiding the time and expense of recovering and histologically examining diminutive polyps that have little or no malignant potential, enforcing standards is of the utmost importance. Despite the endorsement of both the American and the European Societies for Gastrointestinal Endoscopy (ASGE and ESGE) for real-time endoscopic prediction of histology of diminutive colorectal polyps, the basis for these endorsements are the high-quality standards that need be achieved, including adequate training and monitoring of the involved endoscopists.In this issue of Digestive Diseases and Sciences, GarciaAlonso et al. [1] address the fundamental issues involved with training in the field of optical diagnosis for the histological prediction in diminutive colonic polyps. The authors evaluated whether an ex vivo image-based single session followed by self-education training on 100 lesions, with feedback received after each diagnosis, was able to reach the performance thresholds recommended by the ASGE for < 7 mm polyps. The study involved medical students, untrained in either endoscopy or narrow-band imaging (NBI), whose progress was evaluated by the learning curve cumulative summation (LC-CUSUM) in order to identify their level of competency. Diagnostic accuracy was subsequently evaluated during a 9-month period using 180 images of diminutive polyps captured during routine colonoscopies. The study demonstrated that none of the thresholds recommended in the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statement by the ASGE [2] was reached by most evaluators. Nevertheless, an improvement over time in prediction accuracy was observed for all of the raters.Although numerous training modalities have been explored, uncertainty still exists with regard to the best teaching method for optical diagnosis and how best to certify the acquisition of competency. Indeed, even though the NBI International Colorectal Endoscopic (NICE) criteria have been validated through a systematic process to differentiate adenomatous from hyperplastic polyps, optimal teaching methods for predicting colorectal polyp histology with NBI using these criteria have not been developed.A consistent methodology was used in the first reports on NBI characterization of diminutive polyps, which suggested that optical diagnosis could be effectively taught by simple computer-based training modules consisting of still polyp images, without active feedback [3], or short didactic teaching sessions, mainly on trainees. The authors tested the efficacy of a teaching model on an unbiased and naïve population, namely medical students, who were assumed to have little knowledge of optical diagnosis of diminutive polyps via analysis of endoscopi...

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Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile‐serrated lesions in Vietnamese patients

Vu,

Le,

et al. 2024

JGH Open

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Background/AimsSessile‐serrated lesions (SSLs) are challenging to detect due to their typically subtle appearance. The Workgroup serrAted polypS and Polyposis (WASP) classification was developed to diagnose SSLs endoscopically. This study aimed to evaluate the endoscopic characteristics of SSLs and the performance of the WASP classification in the Vietnamese population.MethodsThis cross‐sectional study was carried out on patients with lower gastrointestinal symptoms who underwent colonoscopy at a Vietnamese tertiary hospital. Univariate and multivariate analyses were performed to identify endoscopic features associated with SSLs. The performance of the WASP classification for diagnosing SSLs was assessed, and SSLs were diagnosed according to the 2019 World Health Organization (WHO) criteria.ResultsThere were 2489 patients, with a mean age of 52.1 ± 13.1 years and a female‐to‐male ratio of 1:1.1. A total of 121 specimens from 105 patients were diagnosed with SSLs. According to multivariate analysis, the endoscopic features significantly associated with SSLs were proximal location (odds ratio [OR]: 2.351; 95% confidence interval [CI]: 1.475–3.746), size >5 mm (OR: 2.447; 95% CI: 1.551–3.862), flat morphology (OR: 2.781; 95% CI: 1.533–5.044), irregular shape (OR: 4.516; 95% CI: 2.173–9.388), varicose microvascular vessels (OR: 5.030; 95% CI: 2.657–9.522), and dark spots inside the crypts (OR: 5.955; 95% CI: 3.291–10.776). The accuracy of the WASP classification for diagnosing SSLs was 94.0% (95% CI: 92.8%–95.0%).ConclusionProximal location, size >5 mm, flat morphology, irregular shape, varicose microvascular vessels, and dark spots inside the crypts were significantly associated with SSLs. The WASP classification had high accuracy in the diagnosis of SSLs.

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Effects of Training and Feedback on Accuracy of Predicting Rectosigmoid Neoplastic Lesions and Selection of Surveillance Intervals by Endoscopists Performing Optical Diagnosis of Diminutive Polyps

Cited by 41 publications

References 39 publications

Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

Predictive Narrow-Band Imaging of Colonic Polyps: The Optics Are Good

Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile‐serrated lesions in Vietnamese patients

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