S0520 The Napoleon: A Pilot Feasibility Study of a Small Endoscopic Ruler for Accurate Polyp Measurement

Pochapin, Mark; Khan, Aneal; Rosenberg, Jonathan; Chang, Shannon; Li, Xiaochun; Goldberg, Judith D.; Ghiasian, Ghoncheh; Sharma, Barun Kumar; Knotts, Rita M.; Poppers, David M.

doi:10.14309/01.ajg.0000704128.31399.d5

Cited by 1 publication

(7 citation statements)

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“…Two studies found 62.5 % and 63.9 % accuracy using visual estimation as the only means of determining polyp size 6 7 . Given these significant differences between true polyp size and visual estimation as well as previous data showing superiority of VSE to visual assessment, endoscopists could consider utilizing tools that can provide objective criteria to guide size estimations if clinically significant results are found in confirmatory studies reporting real world outcomes 7 8 9 . Multiple tools have been proposed to aid in estimating polyp sizes.…”

Section: Discussionmentioning

confidence: 99%

“…[6,7] Given these significant differences between true polyp size and visual estimation as well as previous data showing superiority of VSE to visual assessment, endoscopists could consider utilizing tools that can provide objective criteria to guide size estimations if clinically significant results are found in confirmatory studies reporting real world outcomes. [7][8][9] Multiple tools have been proposed to aid in estimating polyp sizes. For biopsy forceps-based measurements, performance is highly variable with one study showing only 37% of polyps measured correctly within 1mm.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[8] However, the study lacked gold standard measurement of polyps after resection to determine true size. [8] For the VSE, one proof of concept study found a 84% relative accuracy that was superior to visual estimation (63.9%) when using symmetrical silicone polyps placed on simulated colonic folds for frontal visualization. [6] Our study adds to the available literature by demonstrating that among measurement devices, VSE yields significantly more accurate measurements within a blinded randomized trial.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…[6,7] Some studies have used specific single-use instruments such as biopsy forceps, snares or rulers that are introduced through the working channel and held next to the polyps to have a reference size to better guide visual assessment. [8,9] However, measurement accuracy is highly variable for these methods, and as they require utilizing a separate tool during the procedure, they have never found widespread adoption outside of research studies. [10,11] Recently, a virtual scale endoscope (VSE) has been developed that can superimpose a virtual scale during live endoscopy (Figure 1-2, video 1).…”

Section: Introductionmentioning

confidence: 99%

“…Not surprisingly subjective visual judgment of polyp size is fraught with inaccurate size estimation 6 7 . Some studies have used specific single-use instruments such as BF, snares or rulers that are introduced through the working channel and held next to the polyps to have a reference size to better guide visual assessment 8 9 . However, measurement accuracy is highly variable for these methods, and as they require utilizing a separate tool during the procedure, they have never found widespread adoption outside of research studies 10 11 .…”

Section: Introductionmentioning

confidence: 99%

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Comparing size measurement of colorectal polyps using a novel virtual scale endoscope, endoscopic ruler or forceps: A preclinical randomized trial

et al. 2023

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Background and Aims: Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (biopsy forceps [BF] or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies. Our aim was to evaluate the performance of VSE when compared to ER and BF-based measurement. Methods: We conducted a preclinical randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and BF. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5, 10, and 20mm thresholds. Results: A total of 360 measurements were performed. The relative accuracy of BF, ER, and VSE was 78.9% (95%CI=76.2-81.5), 78.4% (95%CI=76.0-80.8), and 82.7% (95%CI=80.8-84.8). VSE had significantly higher accuracy compared to BF (p=0.02) and ER (p=0.006). VSE misclassified a lower percentage of polyps >5mm as ≤5mm (9.4%) compared to BF (15.7%) and ER (20.9%). VSE misclassified a lower percentage of ≥20mm polyps as <20mm (8.3%) compared with BF (66.7%) and ER (75.0%). 25.6%, 25.5%, and 22.5% of polyps ≥10mm were misclassified as <10mm with ER, BF, and VSE, respectively. Conclusions: VSE had significantly higher relative accuracy in measuring polyps compared to ER or biopsy forceps assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds.

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