Variability in, and factors associated with, sizing of polyps by endoscopists at a large community practice

Abstract

Background and aims Accurate sizing of polyps at time of colonoscopy is critical for determining surveillance intervals. Endoscopists routinely over- or underestimate the size of polyps at colonoscopy. We evaluated the variability in sizing of polyps among multiple endoscopists, and the effect of patient and physician related factors on polyp size estimation in a large community-based practice. Methods Adult patients who underwent a colonoscopy with polypectomy at five endoscopy centers in Minneapolis/St. Paul by one of 52 endoscopists in 2013 were included in this study. Association of patient, physician, and procedure related factors on polyp sizing was assessed. Results In the study time frame, 38 624 colonoscopies were performed at five ambulatory endoscopy centers. Of these, 16 336 had one or more polyp removed with size information available, and were included in this analysis. There was significant inter-physician variation for estimating polyp sizes larger than 5 mm (intraclass correlation coefficient [ICC] 0.13). Older patient age (OR 1.08, 95 %CI 1.06 – 1.11), and male physician gender (OR 1.92, 95 %CI 1.26 – 2.94) were associated with increased odds of physicians sizing polyps as larger in size. Surveillance procedures had a higher odds of larger polyp sizing compared to screening (OR 0.91, 95 %CI 0.86 – 0.97) and diagnostic procedures (OR 0.86, 95 %CI 0.78 – 0.94). Conclusion In a large community setting, variation of polyp sizing estimates exists between physicians. Male physicians were more likely to size polyps as larger in size. Older patients and patients undergoing surveillance procedures were more likely to have polyps that were sized as larger in size.

Short educational video to improve the accuracy of colorectal polyp size estimation: Multicenter prospective study

“…However, the multivariable logistic regression analysis showed that factors significantly associated with a high improvement (≥10%) of accuracy after the educational video lecture included a lower score in the pretest as well as the category of beginners. Some studies showed interphysician variability in experts for the estimation of polyp size 13,21. Although we initially assumed beginners as a group with a low score in the pretest, experienced endoscopists can also make inaccurate measurements when estimating polyp size.…”

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

“…Surveillance interval recommendations depend strongly on polyp size, but measurement bias is present with evaluation both at endoscopy [34] and pathology [35]. It is known that at endoscopy size estimation is usually biased towards specific numbers (i. e., 5 or 10) while neglecting the others [34 -36], and interobserver variability in visual polyp sizing can be present [37,38], resulting in routine underestimation or overestimation of polyp size [39,40]. However, such bias can be reduced by using a reference standard, such as an open biopsy forceps or snare [41 -43].…”

Artificial intelligence and deep learning for small bowel capsule endoscopy

“…While not replicated in humans, they estimated distance with a mean error of <0.01 cm over 20 cm of travel 21 . Size estimation was less accurate with a mean absolute error of approximately 20%, although this compares favorably to expert endoscopist visual estimates 21,47 …”