Is narrow band imaging superior to high‐definition white light endoscopy in the assessment of diminutive colorectal polyps?

Singh, Rajvinder; Bhat, Yasser M.; Thurairajah, Prem Harichander; Shetti, Mohit P; Jayanna, Mahesh; Nind, Garry; Tam, William; Walmsey, Russell; Bourke, M. J.; Moss, Alan; Chen, Robert; Bampton, Peter A.; Roberts‐Thomson, Ian C.; Schoeman, Mark; Tucker, Graeme

doi:10.1111/jgh.12098

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…White light endoscopy (WLE), has been a standard technique for diagnosis of disease pathology in the upper and lower part of the gastrointestinal (GI) tract for several decades 1 2 . However, until recently, the small bowel was an obscure region requiring invasive intervention for diagnosis and treatment.…”

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confidence: 99%

Wireless fluorescence capsule for endoscopy using single photon-based detection

Al-Rawhani

Beeley

Cumming

2015

Sci Rep

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Fluorescence Imaging (FI) is a powerful technique in biological science and clinical medicine. Current FI devices that are used either for in-vivo or in-vitro studies are expensive, bulky and consume substantial power, confining the technique to laboratories and hospital examination rooms. Here we present a miniaturised wireless fluorescence endoscope capsule with low power consumption that will pave the way for future FI systems and applications. With enhanced sensitivity compared to existing technology we have demonstrated that the capsule can be successfully used to image tissue autofluorescence and targeted fluorescence via fluorophore labelling of tissues. The capsule incorporates a state-of-the-art complementary metal oxide semiconductor single photon avalanche detector imaging array, miniaturised optical isolation, wireless technology and low power design. When in use the capsule consumes only 30.9 mW, and deploys very low-level 468 nm illumination. The device has the potential to replace highly power-hungry intrusive optical fibre based endoscopes and to extend the range of clinical examination below the duodenum. To demonstrate the performance of our capsule, we imaged fluorescence phantoms incorporating principal tissue fluorophores (flavins) and absorbers (haemoglobin). We also demonstrated the utility of marker identification by imaging a 20 μM fluorescein isothiocyanate (FITC) labelling solution on mammalian tissue.

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confidence: 99%

Wireless fluorescence capsule for endoscopy using single photon-based detection

Al-Rawhani

Beeley

Cumming

2015

Sci Rep

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“…[7][8][9] Selfdirected, computer-and Web site-based training modules have been combined with ongoing self-directed feedback and were found to be effective in teaching NBI for characterizing colon polyps and gastric lesions. 10,11 However, most of these studies have assessed ex vivo performance. Those that have assessed in vivo performance have found that the training programs improve learner performance, but have not consistently shown that learners can reach all the established performance thresholds.…”

Section: Trainingmentioning

confidence: 99%

AGA White Paper: Training and Implementation of Endoscopic Image Enhancement Technologies

Gupta

Brill

Canto

et al. 2017

Clinical Gastroenterology and Hepatology

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Endoscopic image-enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal (GI) tract in a manner that complements conventional white light endoscopic imaging. The additional information that is obtained enables the endoscopist to better identify, delineate, and characterize lesions and can facilitate targeted biopsies or, in some cases, eliminate the need to send samples for histologic analysis. Some of these technologies have been available for more than a decade, but despite this fact, there is limited use of these technologies by endoscopists. Lack of formalized training in their use and a scarcity of guidelines on implementation of these technologies into clinical practice are contributing factors. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image-enhancement technologies. This article represents the third of 3 separate documents generated from the workshop and discusses the published literature pertaining to training and outlines a proposed framework for the implementation of endoscopic image-enhancement technologies in clinical practice. There was general agreement among participants in the workshop on several key considerations. Training and competency assessment for endoscopic image-enhancement technologies should incorporate competency-based education paradigms. To facilitate successful training, multiple different educational models that can cater to variations in learning styles need to be developed, including classroom-style and self-directed programs, in-person and web-based options, image and video atlases, and endoscopic simulator programs. To ensure safe and appropriate use of these technologies over time, refresher courses, skill maintenance programs, and options for competency reassessment should be established. Participants also generally agreed that although early adopters of novel endoscopic image-enhancement modalities can successfully implement these technologies by pursuing training and ensuring self-competency, widespread implementation is likely to require support from GI societies and buy-in from other key stakeholders including payors/purchasers and patients. Continued work by manufacturers and the GI societies in providing training programs and patient education, working with payors and purchasers, and creating environments and policies that motivate endoscopists to adopt new practices is essential in creating widespread implementation.

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“…A wide variety of learning tools has been described, including classroom type[6], self-directed computer-based[3] or web-based teaching programs[7]. Still pictures, videos or both have been used to explain the optical features of each type of polyp[8,9]. However, there are no head-to-head comparisons between learning tools and most of them have not been validated.…”

Section: Introductionmentioning

confidence: 99%

Non-guided self-learning program for high-proficiency optical diagnosis of diminutive and small colorectal lesions: A single-endoscopist pilot study

Bustamante-Balén¹,

Satorres²,

Puchades³

et al. 2019

WJG

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BACKGROUNDThe implementation of optical diagnosis (OD) of diminutive colorectal lesions in clinical practice has been hampered by differences in performance between community and academic settings. One possible cause is the lack of a standardized learning tool. Since the factors related to better learning are not well described, strong evidence upon which a consistent learning tool could be designed is lacking. We hypothesized that a self-designed learning program may be enough to achieve competency in OD of diminutive lesions of the colon.AIMTo assess the accuracy of OD of diminutive lesions in real colonoscopies after application of a self-administered learning program.METHODSThis was a single-endoscopist prospective pilot study, in which an experienced endoscopist followed a self-designed, self-administered learning program in OD of colorectal lesions. An assessment phase divided in two halves with a 6-mo period in between without performance of OD was developed in a population-based colorectal cancer screening program. The accomplishment of the Preservation and Incorporation of Valuable Endoscopic Innovations criteria and performance measures were calculated overall and in the two halves of the assessment phase, assessing their response to the 6-mo stopping period. The evolution of performance through blocks of 50 lesions was also assessed.RESULTSOverall, 152 patients and 522 lesions (≤ 5 mm: 399, and 6-9 mm: 123) were included. The negative predictive value for the OD of adenoma in rectosigmoid lesions diagnosed with high confidence was 91.7% [95% confidence interval (CI): 87.3-96.6]. The proportion of agreement on surveillance interval between OD and pathological diagnosis was higher than 95%. Overall accuracy for diminutive lesions diagnosed with high confidence was 89.5% (95%CI: 86.3-92.7). The overall accuracy of OD was similar in the two halves of the assessment phase [90.1 (95%CI: 85.6-94.7) vs 88.2 (95%CI: 87.9-95.9)]. All the other performance parameters were also equivalent, except for specificity. Specificity, negative predictive value and accuracy were the parameters most affected by the stopping period between the two halves. Upon analyzing trends on blocks of 50 lesions, an improvement on sensitivity (P = 0.02) was detected only in the first half and an improvement on accuracy (P = 0.01) was detected only in the second half.CONCLUSIONA self-administered learning program is sufficient to achieve expert-level OD. To maintain performance, continuous practice is needed, with a refresher course following any long non-practice period.

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Is narrow band imaging superior to high‐definition white light endoscopy in the assessment of diminutive colorectal polyps?

Cited by 15 publications

References 18 publications

Wireless fluorescence capsule for endoscopy using single photon-based detection

Wireless fluorescence capsule for endoscopy using single photon-based detection

AGA White Paper: Training and Implementation of Endoscopic Image Enhancement Technologies

Non-guided self-learning program for high-proficiency optical diagnosis of diminutive and small colorectal lesions: A single-endoscopist pilot study

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