Nikolaj Nerup, MD from the Department of Surgical Gastroenterology at Copenhagen University Hospital in Herlev, Denmark discusses this Original Article “Assessment of colonoscopy by use of magnetic endoscopic imaging: design and validation of an automated tool.”

The focus of our study was to develop and explore the validity of an automated unbiased assessment tool. The tool should give an easily accessible, reliable, and valid measure of endoscopic performance in colonoscopy.

Yield and safety of colonoscopy are highly dependent on operator competence. Existing tools for assessing competence is time-consuming and based on direct observation, making them prone for bias. As national screening programs in colonoscopy are introduced in several countries, the need for unbiased assessment of the performance of colonoscopy is crucial to certify endoscopists.

We developed the colonoscopy progression score (CoPS) based on magnetic endoscopic imaging (MEI). We recruited 10 experienced endoscopy consultants with a minimum experience of 350 colonoscopies (median 2000, range 350–4000). Eleven trainees participating in a simulator-based colonoscopy training program were recruited for comparison. The testing was done in a realistic setup, with a real colonoscope, real MEI, and a realistic standardized model of the human colon (Kagaku Colonoscope Training Model).  Our tool was able to distinguish between trainee and experienced endoscopists in an easy and difficult case scenario on a physical colonoscopy simulator; it is a dynamic, fully objective instrument and offers the possibility of live feedback.

Figure 1. Two examples of a colonoscopy progression map (CoP-map) showing the performances of an experienced (left) and a trainee (right) endoscopist. The dots represent the position of the tip of the scope, 5 dots per second. Left, Steady progression through the simulated colon is shown. The colonoscopy progression score (CoPS) for this procedure was 515. Right, Uneven progression with problems navigating through several parts of the simulated colon is shown. The CoPS for this procedure was 35.

In addition to the CoPS, the method also has the opportunity to build a graphical map of the progression of the procedure as a plot of the position of the. It is clearly shown that a steady, even progression would result in a map with equally spaced dots, almost as a “drawing” of the colon model, whereas a trainee’s insecure uneven progression would result in a dense pattern of dots in problem areas. This colonoscopy progression map (CoP-map) can be printed and used to evaluate the training procedure, along with the CoPS.

With further testing and studies of the tool we hope to establish competency criteria for different simulator case-scenarios and ultimately clinical colonoscopy.

Read the abstract for this article online.

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