Original article
Clinical endoscopy
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

https://doi.org/10.1016/j.gie.2013.07.032Get rights and content

Background

Experts can accurately characterize the histology of diminutive polyps with narrow-band imaging (NBI). There are limited data on the performance of non-experts.

Objective

To assess the impact of a computer-based teaching module on the accuracy of predicting polyp histology with NBI by non-experts (in academics and community practice) by using video clips.

Design

Prospective, observational study.

Setting

Academic and community practice.

Participants

A total of 15 gastroenterologists participated—5 experts in NBI, 5 non-experts in academic practice, and 5 non-experts in community practice.

Intervention

Participants reviewed a 20-minute, computer-based teaching module outlining the different NBI features for hyperplastic and adenomatous polyps.

Main Outcome Measurements

Performance characteristics in characterizing the histology of diminutive polyps with NBI by using short video clips before (pretest) and after (posttest) reviewing the teaching module.

Results

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 in NBI was significantly better than non-experts in both academic and community practice.

Limitations

Selection bias in selecting good quality videos. Performance not assessed during live colonoscopy.

Conclusion

Academic and community gastroenterologists without prior experience in NBI can achieve significant improvements in characterizing diminutive polyp histology after a brief computer-based training. The durability of these results and applicability in everyday practice are uncertain.

Section snippets

Teaching module

An audiovisual teaching presentation was prepared in Power Point (Microsoft Corp, Redmond, Wash) by one investigator with experience in polyp histology characterization with NBI (A.R.). This presentation included 34 slides and was approximately 20 minutes in duration. The contents of this presentation included a brief introduction on NBI, followed by a demonstration of the different NBI surface patterns that can help differentiate between hyperplastic and adenomatous polyps. The NBI patterns

Statistical analysis

We assumed that the accuracy of the non-experts (groups B and C) in histology characterization of diminutive polyps with NBI in the pretest would be 60%. This was estimated to improve to 75% in the posttest after participants reviewed the teaching module. A sample size of 200 observations (40 videos × 5 reviewers) was calculated to be adequate to detect this difference with 80% power and an alpha of 0.05. The performance characteristics of the reviewers were calculated by comparing the

Reviewers

There were 5 reviewers in each of the 3 groups. Group A included experts in NBI who had been in gastroenterology practice for a mean of 6 years (range 2-12 years) and who performed 400 to 1000 colonoscopies annually. All of them had experience in polyp histology characterization, having performed more than 500 procedures with NBI. The time taken to review the pretest and posttest videos was 37 minutes and 29.8 minutes, respectively.

Group B included non-experts in academics who had been in

Discussion

The ability to accurately characterize the histology of diminutive polyps in real time during colonoscopy can lead to a paradigm shift from the current practice of resecting and submitting all diminutive polyps to pathology. This practice of submitting all diminutive polyps to pathology is a significant drain to our health care resources, with very limited clinical benefits in return. Therefore, a change in practice that is economically more efficient without jeopardizing patient outcomes would

Acknowledgments

We acknowledge Drs Mukul Khandelwal, Gary Payman, Sreekant Chandrupatla, Jyotsana Talapenini, and Syed F. Jafri for their participation in this study.

References (24)

Cited by (0)

DISCLOSURE: This work was supported by the Michael V. Sivak, Jr., MD, Endoscopic Research Award and the Endoscopic Research Career Development Award from theAmerican Society for Gastrointestinal Endoscopyto A. Rastogi. A. Rastogi also received a research grant from Olympus America. E. Dekker received equipment on loan and research support from Olympus. T. Kaltenbach received a research grant from and is a consultant for Olympus America. P. Sharma received a research grant from Olympus America. All other authors disclosed no financial relationships relevant to this publication.

See CME section; p. 498.

If you would like to chat with an author of this article, you may contact Dr Rastogi at [email protected].

View full text