Amit Rastogi, MD Director of Endoscopy at the Kansas City VA Medical Center and Associate Professor at the University of Kansas, discusses his Original Article “Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study.”
The main focus of this study was to assess the impact of a computer-based teaching module on narrow-band imaging (NBI) polyp patterns on the accuracy of predicting polyp histology by non-experts (in academic and community practices). We also compared the performance of non-experts with that of experts and utilized videos of diminutive polyps for this study.
Recently there has been a lot of interest in characterizing polyp histology real-time during colonoscopy. The main advantage of this practice would be the enormous cost savings that would ensue if we could avoid sending diminutive polyps to histology by characterizing them during colonoscopy and then “resecting and discarding” them. Experts have shown high accuracy in the real-time characterization of polyp histology. For the widespread implementation of this strategy, we have to develop teaching tools for non-experts so that they can also gain proficiency. Computer based teaching tools have the advantage of widespread dissemination. We therefore developed one such tool and used it in this study to evaluate if it was effective in training non-experts in both academic and community practice.
Figure 1. A, Fine capillary network but absent mucosal pattern (bland pattern). B, Circular pattern with dots (dark dots surrounded by clear white areas).
Five non-experts each in academic and community practice and 5 experts participated. They evaluated short video clips of 40 diminutive polyps under NBI (pretest) and characterized the histology. They then reviewed the computer based teaching presentation. This showed the different NBI patterns suggestive of hyperplastic polyps and adenoma. The patterns for hyperplastic polyps were bland pattern and circular pattern with dots. While those for adenomas were round or oval and tubulogyrus. Following this they viewed another set of 40 videos (posttest). Non-experts in academic practice showed a significant improvement in the sensitivity (54% vs 79%; P<.001), accuracy (64% vs 81%; P<.001) and proportion of high confidence diagnoses (49% vs 69%; P <.001) in the posttest. Non-experts in community practice had significantly higher sensitivity (58% vs 75%; P=.004), specificity (76% vs 90%; P=.04), accuracy (64% vs 81%; P<.001) and proportion of high confidence diagnoses (49% vs 72%; P<.001) in the posttest. Performance of experts was significantly better than both non-experts in academic and community practice.
Figure 2. A, Round and/or oval pattern (dark round or oval lines surrounding clear white areas). B, Tubulogyrus pattern (linear and convoluted tubular structures).
Future studies should test the performance of non-experts in live colonoscopy during day to day clinical practice to validate the finding of this study.
Real time polyp histology has the potential for enormous cost savings and making colonoscopy more cost effective. ASGE has published the PIVI document that outlines the benchmarks that need to be achieved for real-time histology of diminutive polyps and future studies are warranted to see if these thresholds can be achieved.
Find this article on pages 390-398 of the journal or online.
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