Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program

doi:10.1016/j.gie.2010.01.054

Gastrointestinal Endoscopy

Volume 72, Issue 1, July 2010, Pages 127-135

https://doi.org/10.1016/j.gie.2010.01.054 Get rights and content

Background

Previous reports assessing diagnostic skill using narrow-band imaging (NBI) and pit pattern analysis for colorectal polyps involved only highly experienced endoscopists.

Objective

To evaluate diagnostic skills of less-experienced endoscopists (LEE group) for differentiation of diminutive colorectal polyps by using NBI and pit pattern analysis with and without magnification after an expanded training program.

Design

Prospective study.

Patients

This study involved 32 patients with 44 colorectal polyps (27 adenomas and 17 hyperplastic polyps) of ≤5 mm that were identified and analyzed by using conventional colonoscopy as well as non-magnification and magnification NBI and chromoendoscopy followed by endoscopic removal for histopathological analysis.

Intervention

Before a training course, 220 endoscopic images were distributed in randomized order to residents with no prior endoscopy experience (NEE group) and to the LEE group, who had performed colonoscopies for more than 5 years but had never used NBI. The 220 images were also distributed to highly experienced endoscopists (HEE group) who had routinely used NBI for more than 5 years. The images were distributed to the NEE and LEE groups again after a training class. Magnification NBI and chromoendoscopy images were assessed by using the Sano and Kudo classification systems, respectively.

Main outcome measurements

Diagnostic accuracy and interobserver agreement for each endoscopic modality in each group.

Results

Diagnostic accuracy was significantly higher, and kappa (κ) values improved in the LEE group for NBI with high magnification after expanded training. Diagnostic accuracy and κ values when using high-magnification NBI were highest among endoscopic techniques for the LEE group after such training and the HEE group (accuracy 90% vs 93%; κ = 0.79 vs 0.85, respectively).

Limitations

Study involved only polyps of ≤5 mm.

Conclusion

Using high-magnification NBI increased the differential diagnostic skill of the LEE group after expanded training so that it was equivalent to that of the HEE group.

Section snippets

Patients

Patients scheduled for a total colonoscopy at Okayama University Hospital and Sumitomo Besshi Hospital between September and October 2008 were invited to participate in this study. Informed consent was obtained from all patients before their examinations. Patients with inflammatory bowel disease, familial adenomatous polyposis, an international normalized ratio greater than 2.0, or a platelet count less than 50,000/mm³ were excluded from this study.

Colonoscopy and polyp assessment protocol

Bowel preparation consisted of patients

Clinicopathological features of colorectal lesions

Seventy-two consecutive patients were enrolled in this study for prospective endoscopic evaluation. A total of 44 lesions of ≤5 mm were identified and analyzed in 32 patients (Table 1). Mean (± standard deviation [SD]) patient age was 61.2 ± 12.3 years, and the male/female ratio was 2.2:1. Bowel preparation was considered adequate in all examinations, and complete colonoscopy was performed to the cecum in every case. There were no complications during any procedure. Of the 44 lesions, 37 were

Discussion

Endoscopic diagnostic tools and technology are expected to be accurate and provide reliably reproducible agreement as well as be easy to use, readily available, and relatively inexpensive, but sufficient skill on the part of the endoscopist is still required for proper diagnosis. Our prospective study demonstrated significant improvement in the LEE group in diagnostic accuracy when using NBI and CE after undergoing limited but intensive training. The improved diagnostic accuracy of the LEE

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: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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Original articleClinical endoscopyDiagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program

Background

Objective

Design

Patients

Intervention

Main outcome measurements

Results

Limitations

Conclusion

Section snippets

Patients

Colonoscopy and polyp assessment protocol

Clinicopathological features of colorectal lesions

Discussion

Gastrointest Endosc Clin N Am

Lancet

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Clin Gastroenterol Hepatol

Prevention of colorectal cancer by colonoscopic polypectomyThe National Polyp Study Workgroup

N Engl J Med

Long-term risk of colorectal cancer after excision of rectosigmoid adenomas

N Engl J Med

Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence

Gut

Genetic alterations during colorectal-tumor development

N Engl J Med

Efficacy of magnifying endoscopy in the differential diagnosis of neoplastic and non-neoplastic polyps of the large bowel

Dis Colon Rectum

Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps

Dig Dis Sci

Clinical accuracy in the diagnosis of small polyps using the flexible fiberoptic sigmoidoscope

Dis Colon Rectum

Physician accuracy in diagnosing colorectal polyps

Dis Colon Rectum

Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy

Gut

Original article
Clinical endoscopy
Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program