Post written by Fumiaki Ishibashi, MD, PhD, from the International University of Health and Welfare Ichikawa Hospital, Chiba, Japan.

Specific visual gaze pattern (VGP) during colonoscopy is assumed to be related to high colorectal adenoma detection. This randomized controlled trial (RCT) evaluated the optimal VGP that enabled the highest adenoma detection.

We developed an eye-tracking and feedback system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. A total of 189 patients were allocated to the 3 intervention groups with different levels of screen division (4 × 4, 5 × 5, and 6 × 6) and the control group. The number of adenomatous polyps per colonoscopy and adenoma detection rate were significantly higher in the 6 × 6 group than the control group (1.82 ± 2.41 vs 0.59 ± 1.17, P = .002; 68.9% vs 30.8%, P = .002). Importantly, the rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (R = 0.964, P = .0363).

To our knowledge, no studies have prospectively evaluated the relationship between VGP during colonoscopy and adenoma detection, and this study is the first report that successfully showed the substantial correlation between specific VGP, the peripheral gaze rate during the scope withdrawal phase, and the number of adenomas detected in 1 colonoscopy.

This study highlights the possibility of an endoscopist’s VGP intervention for quality control during colonoscopy. Further large, unbiased RCTs should be undertaken to verify our results. We are conducting the following large-scale, multicenter RCT to gather concrete evidence.

Representative heat-map drawn based on endoscopists’ gaze positions. In the control group, the gazing position is concentrated in the center of the screen, whereas in the 6 × 6 group, the gazing point is dispersed to the bottom of the screen.

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