Endoscopic characterization of small colonic polyps: baseline performance of experienced endoscopists is no different to that of medical students

摘要

- Studies examining the impact of training modules on characterisation of diminutive colonic polyps (DCP) show varying results. AimWe aimed to assess the impact of a novel web-based training module on the accuracy in-vivo characterisation of DCPs using different imaging modalities. Differences between groups with varying degrees of endoscopic experience were also assessed. - 90 images of 30 DCPs viewed with high definition white light (HDWL), i-Scan and chromoendoscopy were included in an online test module. Testing was undertaken before and after completing a novel web-based in-vivo characterisation training module. 21 subjects (medical students (MS), gastroenterology trainees (GT) and gastroenterology consultants (GC)) undertook the tests and training module. - No significant difference in overall accuracy was found between the three groups either pre (MS 59.1%, GR 65.7%, GC 62.4%, P = ns for all 3 comparisons) or post-training (MS 69.2%, GR 71.1%, GC 71.3%, P = ns for all 3 comparisons). Accuracy improved significantly for all 3 groups post-training (P0.001) as did interobserver agreement. No significant differences in accuracy between modalities was found pre-training (HDWL 64.8%, i-Scan 60.0%, Chromo 62.2%, P = ns). Post-training accuracy with HDWL and Chromo was better than with i-Scan (HDWL 72.9% vs i-Scan 65.1%, P =0.002; i-Scan 65.1% vs Chromo 73.7%, P0.001). The proportion of high confidence predictions increased from 25.7% to 41.5%, with a high confidence prediction accuracy of 81.7%.- Skills for in-vivo characterisation of DCPs are not acquired through endoscopic experience alone. A novel web-based training intervention results in modest improvements in accuracy with further improvements likely to require more prolonged training.