Non-guided self-learning program for high-proficiency optical diagnosis of diminutive and small colorectal lesions: A single-endoscopist pilot study

Abstract

BACKGROUNDThe implementation of optical diagnosis (OD) of diminutive colorectal lesions in clinical practice has been hampered by differences in performance between community and academic settings. One possible cause is the lack of a standardized learning tool. Since the factors related to better learning are not well described, strong evidence upon which a consistent learning tool could be designed is lacking. We hypothesized that a self-designed learning program may be enough to achieve competency in OD of diminutive lesions of the colon.AIMTo assess the accuracy of OD of diminutive lesions in real colonoscopies after application of a self-administered learning program.METHODSThis was a single-endoscopist prospective pilot study, in which an experienced endoscopist followed a self-designed, self-administered learning program in OD of colorectal lesions. An assessment phase divided in two halves with a 6-mo period in between without performance of OD was developed in a population-based colorectal cancer screening program. The accomplishment of the Preservation and Incorporation of Valuable Endoscopic Innovations criteria and performance measures were calculated overall and in the two halves of the assessment phase, assessing their response to the 6-mo stopping period. The evolution of performance through blocks of 50 lesions was also assessed.RESULTSOverall, 152 patients and 522 lesions (≤ 5 mm: 399, and 6-9 mm: 123) were included. The negative predictive value for the OD of adenoma in rectosigmoid lesions diagnosed with high confidence was 91.7% [95% confidence interval (CI): 87.3-96.6]. The proportion of agreement on surveillance interval between OD and pathological diagnosis was higher than 95%. Overall accuracy for diminutive lesions diagnosed with high confidence was 89.5% (95%CI: 86.3-92.7). The overall accuracy of OD was similar in the two halves of the assessment phase [90.1 (95%CI: 85.6-94.7) vs 88.2 (95%CI: 87.9-95.9)]. All the other performance parameters were also equivalent, except for specificity. Specificity, negative predictive value and accuracy were the parameters most affected by the stopping period between the two halves. Upon analyzing trends on blocks of 50 lesions, an improvement on sensitivity (P = 0.02) was detected only in the first half and an improvement on accuracy (P = 0.01) was detected only in the second half.CONCLUSIONA self-administered learning program is sufficient to achieve expert-level OD. To maintain performance, continuous practice is needed, with a refresher course following any long non-practice period.

Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

“…Mabe et al [50] indicated that the learning effect might decrease if endoscopists do not continue their learning practice, but the required frequency of training is unclear. The recently published study of Bustamante-Balén et al [92] shows that, following a non-practice period of 6 months, a drop in performance parameters occurs, and that it takes 150 lesions to get back to previous "expert" levels. Repetitive practice therefore seems crucial for maintaining competence.…”

“…In this article, the authors mention that 250 polyps are needed to achieve competence. A Spanish study demonstrated that, following a non-practice period of 6 months, a drop in performance parameters occurs, and that it takes 150 lesions to get back to previous "expert" levels [92].…”

The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

“…Although a strict adherence to NICE and Kudo classifications was not required, endoscopists used them as part of the optical diagnostic process. Firstly, HPs and SSLs cannot be differentiated within the NICE 1 category [27] and the WASP classification [28] was not recorded. On the other hand, the well-recognized interobserver variability for histological differentiation between SSLs and HPs might also bias the optical diagnosis results [29].…”