Introduction Acetic acid chromoendoscopy (AAC) is increasingly used by both expert and non-expert endoscopists for detection of Barrett’s neoplasia. However, there is no validated training strategy to achieve competence. The aim of this study was to identify the need for training, develop a validated training tool in the use of AAC and evaluate its impact on neoplasia detection, degree of confidence of the endoscopists & attitude towards switching to AAC from conventional Barrett’s surveillance strategy.
Methods A validated assessment tool of 40 images and 20 videos was developed. 13 endoscopists experienced in Barrett’s endoscopy and no formal training in AAC (7 consultants, 6 nurse endoscopists) underwent training. Participants underwent: 1. baseline assessment→online-training→2.assessment→ interactive seminar with live cases→3.assessment.
Results Experienced endoscopists lack lesion recognition skills with AAC, Consultants perform no better than nurse-endoscopists. There were significant increases in accuracy, sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) following the online training module (Table 1) to a level that meets ASGE PIVI requirements. There was additional gain from the interactive workshop with live & inter-observer agreement improved.
The training intervention led to an improvement in the endoscopist’s confidence in AAC, with the mean pre-training confidence level rising from 2.5 (5 point scale) to 3.9 post-training (p < 0.001). The training module improved the willingness of the endoscopists in changing practice from Seattle protocol to AAC-targeted biopsy with mean pre-training confidence score of 2.6 (5 point scale) rising to 3.8 post-training(p < 0.001).
Our data demonstrates the need for training as baseline performance, even by experts, was poor
We were successful in developing a validated online training and testing tool for AAC
Our training tool improved performance of all endoscopists to a clinically significant (PIVI standard) level & improved their confidence & willingness in the use of AAC.
Disclosure of Interest None Declared