Improved Real-Time Optical Diagnosis of Colorectal Polyps Following a Comprehensive Training Program

What Is the Hang-Up With Optical Diagnosis of Diminutive Colorectal Polyps?

“…The ability to optically diagnose polyp histology is not innate and requires training and time. In the current study by Bae et al, 15 15 endoscopists at Seoul National University entered an intense training program they dubbed Gangnam-READI time optical DIagnosis (Gangnam-READI). Predictions were based on the Workgroup on serrAted polypS classification, 16 which uses the narrow-band imaging international colorectal endoscopic classification, 17 with 4 additional features to characterize sessile serrated polyps.…”

“…Although early studies showed that endoscopists without prior expertise in optical diagnosis were unable to achieve the benchmarks set forth by the ASGE, [18][19][20][21][22] multiple recent studies, [23][24][25] including this one, 15 have shown that endoscopists who undergo high-quality training as a group can achieve the PIVI benchmarks. There are several considerations in deciding whether these data can translate to routine clinical practice.…”

“…There are several considerations in deciding whether these data can translate to routine clinical practice. As Bae et al 15 outlined, a structured training program is a necessary prerequisite to successful optical diagnosis in vivo. Endoscopy practices would need to have access to validated training methods, dedicate resources to ensuring training is available to endoscopists, and allow endoscopists time for training and retraining as needed.…”

“…Of the studies that do report the outcomes, only 17% to 59% of endoscopists were able to achieve both PIVI thresholds. 15,18,23,25 Thus, endoscopy groups would need to decide which endoscopists can practice optical diagnosis and how to monitor performance over time to ensure ongoing competence. This variability in performance is likely a deterrent to universally adopting the strategy.…”

“…9 However, it is unclear if these cost savings can be generalized to widespread application of optical diagnosis as these prior analyses relied on assumptions about optical diagnostic performance among experts in advanced imaging. [29][30][31] The proportion of high-confidence diagnoses is significantly lower among endoscopists who are naive to advanced imaging compared with experts (70%-78% 15,22,23 vs 80%-90% 29,30 ). Thus, there would be a larger proportion of polyps that require histologic analysis (and associated cost) than previously assumed.…”