Training methods in optical diagnosis and characterization of colorectal polyps: a systematic review and meta-analysis

Abstract

Background and study aims Correct optical diagnosis of colorectal polyps is crucial to implement a resect and discard strategy. Training methods have been proposed to reach recommended optical diagnosis thresholds. The aim of our study was to present a systematic review and meta-analysis on optical diagnosis training.

Methods PubMed/Medline and Cochrane databases were searched between 1980 and October 2019 for studies reporting outcomes on optical diagnosis training of colorectal polyps. The primary outcome was optical diagnosis accuracy compared to histological analysis pre-training and post-training intervention. Subgroup analyses of experienced/trainee endoscopists, training methods, and small/diminutive polyps were included.

Results Overall, 16 studies met inclusion criteria, analyzing the impact of training on 179 endoscopists. Pre-training accuracy was 70.3 % (6416/9131 correct diagnoses) whereas post-training accuracy was 81.6 % (7416/9213 correct diagnoses) (risk ratio [RR] 1.17; 95 % confidence interval [CI]: 1.09–1.24, P < 0.001). In experienced endoscopists, accuracy improved from 69.8 % (3771/5403 correct diagnoses) to 82.4 % (4521/5485 correct diagnoses) (RR 1.20; 95 % CI: 1.11–1.29, P < 0.001). Among trainees, accuracy improved from 69.6 % (2645/3803 correct diagnoses) to 78.8 % (2995/3803 correct diagnoses) (RR 1.14; 95 % CI 1.06–1.24, P < 0.001). In the small/diminutive polyp subgroup, accuracy improved from 68.1 % (3549/5214 correct diagnoses) to 77.1 % (4022/5214 correct diagnoses) in (RR 1.16 95 % CI 1.08–1.24 P < 0.001). On meta-regression analysis, the improvement in accuracy did not differ between computerized vs. didactic training approaches for experienced (P = 0.792) and trainee endoscopists (P = 0.312).

Conclusions Optical diagnosis training is effective in improving accuracy of histology prediction in colorectal polyps. Didactic and computer-based training show comparable effectiveness in improving diagnostic accuracy.

Publication History

Received: 12 August 2020

Accepted: 09 December 2020

Article published online:
22 April 2021

• References

• 1 Bisschops R, East JE, Hassan C. et al. Correction: Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: C6
• 2 Abu Dayyeh BK, Thosani N, Konda V. et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16
• 3 Solon C, Klausnitzer R, Blissett D. et al. Economic value of narrow band imaging versus white light endoscopy for the characterization of diminutive polyps in the colon: systematic literature review and cost-consequence model. J Med Econ 2016; 19: 1040-1048
• 4 Iacucci M, Trovato C, Daperno M. et al. Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps. Endoscopy 2018; 50: 779-789
• 5 Bisschops R, Hassan C, Bhandari P. et al. BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with blue light imaging. Endoscopy 2018; 50: 211-220
• 6 Bhandari P, Thayalasekaran S, Keisslich R. et al. Detection and characterization of colorectal polyps using high-definition white light and i-Scan: Evidence-based consensus recommendations using a modified Delphi process. United European Gastroenterol J 2018; 6: 748-754
• 7 Siau K, Iacucci M, Dunckley P. et al. The impact of COVID-19 on gastrointestinal endoscopy training in the United Kingdom. Gastroenterology 2020; 159: 1582-1585
• 8 Keswani RN, Sethi A, Repici A. et al. How to maximize trainee education during the coronavirus disease-2019 pandemic: perspectives from around the world. Gastroenterology 2020; 159: 26-29
• 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
• 10 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
• 11 Higgins JP, Altman DG, Gotzsche PC. et al. The Cochrane Collaborationʼs tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
• 12 Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342: d549
• 13 Deeks JJ, Higgins JPT, Altman DG. Chapter 10: Analysing data and undertaking meta-analyses. 2020 https://training.cochrane.org/handbook/current/chapter-10
• 14 Rogart JN, Jain D, Siddiqui UD. et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc 2008; 68: 1136-1145
• 15 Higashi R, Uraoka T, Kato J. et al. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 2010; 72: 127-135
• 16 Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc 2010; 72: 572-576
• 17 Ignjatovic A, Thomas-Gibson S, East JE. et al. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc 2011; 73: 128-133
• 18 Coe SG, Thomas C, Crook J. et al. Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: impact of endoscopic quality improvement program. Gastrointest Endosc 2012; 76: 118-125 e1
• 19 Rastogi A, Rao DS, Gupta N. et al. 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. Gastrointest Endosc 2014; 79: 390-398
• 20 Sinh P, Gupta N, Rao DS. et al. Community gastroenterologists can learn diminutive colon polyp histology characterization with narrow band imaging by a computer-based teaching module. Dig Endosc 2015; 27: 374-380
• 21 JE IJ, Bastiaansen BA, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
• 22 Sikong Y, Lin X, Liu K. et al. Effectiveness of systematic training in the application of narrow-band imaging international colorectal endoscopic (NICE) classification for optical diagnosis of colorectal polyps: Experience from a single center in China. Dig Endosc 2016; 28: 583-591
• 23 Basford P, Longcroft-Wheaton G, Higashi R. et al. Colonic lesion characterisation skills among UK endoscopists and the impact of a brief training intervention. Frontline Gastroenterol 2017; 8: 2-7
• 24 Aihara H, Kumar N, Thompson CC. A Web-based education program for colorectal lesion diagnosis with narrow band imaging classification. Digestion 2018; 98: 11-18
• 25 Bae JH, Lee C, Kang HY. et al. Improved real-time optical diagnosis of colorectal polyps following a comprehensive training program. Clin Gastroenterol Hepatol 2019; 17: 2479-2488 e4
• 26 Basford P, Brown J, Cooper S. et al. Endoscopic characterization of small colonic polyps: baseline performance of experienced endoscopists is no different to that of medical students. Endosc Int Open 2019; 7: E403-E411
• 27 Subramaniam S, Hayee B, Aepli P. et al. Optical diagnosis of colorectal polyps with Blue Light Imaging using a new international classification. United European Gastroenterol J 2019; 7: 316-325
• 28 Smith SCL, Saltzman J, Shivaji UN. et al. Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer-based self-learning module in gastroenterology trainees. Digest Endosc 2019; 31: 535-543
• 29 Gralnek IM, Hassan C, Beilenhoff U. et al. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and the COVID-19 pandemic. Endoscopy 2020; 52: 483-490
• 30 Gralnek IM, Hassan C, Dinis-Ribeiro M. COVID-19 and endoscopy: implications for healthcare and digestive cancer screening. Nat Rev Gastroenterol Hepatol 2020;
• 31 Kissler SM, Tedijanto C, Goldstein E. et al. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 2020; 368: 860-868
• 32 East JE, Vleugels JL, Roelandt P. et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2016; 48: 1029-1045