Endoscopy 2018; 50(07): 701-707
DOI: 10.1055/s-0044-101026
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy

Mariam Lami
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Harsimrat Singh
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
James H. Dilley
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Hajra Ashraf
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Matthew Edmondon
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Felipe Orihuela-Espina
2   Instituto Nacional de Astrofisica, Optica y Electronica (INAOE), Mexico
,
Jonathan Hoare
3   Department of Interventional Endoscopy, St. Mary’s Hospital, Imperial College, London, United Kingdom
,
Ara Darzi
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Mikael H. Sodergren
1   Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
› Author Affiliations
Further Information

Publication History

submitted 07 September 2017

accepted after revision 04 December 2017

Publication Date:
07 February 2018 (online)

Abstract

Background The adenoma detection rate (ADR) is an important quality indicator in colonoscopy. The aim of this study was to evaluate the changes in visual gaze patterns (VGPs) with increasing polyp detection rate (PDR), a surrogate marker of ADR.

Methods 18 endoscopists participated in the study. VGPs were measured using eye-tracking technology during the withdrawal phase of colonoscopy. VGPs were characterized using two analyses – screen and anatomy. Eye-tracking parameters were used to characterize performance, which was further substantiated using hidden Markov model (HMM) analysis.

Results Subjects with higher PDRs spent more time viewing the outer ring of the 3 × 3 grid for both analyses (screen-based: r = 0.56, P = 0.02; anatomy: r = 0.62, P < 0.01). Fixation distribution to the “bottom U” of the screen in screen-based analysis was positively correlated with PDR (r = 0.62, P = 0.01). HMM demarcated the VGPs into three PDR groups.

Conclusion This study defined distinct VGPs that are associated with expert behavior. These data may allow introduction of visual gaze training within structured training programs, and have implications for adoption in higher-level assessment.

 
  • References

  • 1 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. New Engl J Med 2012; 366: 687-696
  • 2 Chaptini L, Laine L. Can I improve my adenoma detection rate?. J Clin Gastroenterol 2015; 49: 270-281
  • 3 Williams JE, Holub JL, Faigel DO. Polypectomy rate is a valid quality measure for colonoscopy. Gastrointest Endosc 2011; 73: 498-506
  • 4 Elhanafi S, Ortiz AM, Yarlagadda A. et al. Estimation of the adenoma detection rate from the polyp detection rate by using a conversion factor in a predominantly Hispanic population. J Clin Gastroenterol 2014; 49: 589-593
  • 5 Dreiseitl S, Pivec M, Binder M. Differences in examination characteristics of pigmented skin lesions: results of eye tracking study. Artificial Intelligence in Med 2012; 54: 201-205
  • 6 Edmondson MJ, Pucher PH, Sriskandarajah K. et al. Looking towards objective quality evaluation in colonoscopy: analysis of visual gaze patterns. J Gastroenterol Hepatol 2016; 31: 604-609
  • 7 Tien T, Pucher PH, Sodergren MH. et al. Difference in gaze behaviour of expert and junior surgeons performing open inguinal hernia repair. Surg Endosc 2015; 29: 405-413
  • 8 Almansa C, Shahid MW, Heckman MG. et al. Association between visual gaze patterns and adenoma detection rate during colonoscopy: a preliminary investigation. Am J Gastroenterol 2011; 106: 1070-1074
  • 9 Dik VK, Hooge IT, van Oijen MG. et al. Measuring gaze patterns during colonoscopy: a useful tool to evaluate colon inspection?. Utrecht: Eur J Gastroenterol Hepatol 2016; 28: 1400-1406
  • 10 Lai EJ, Calderwood AH, Doros G. et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-orientated research. Gastrointest Endosc 2009; 69: 620-625
  • 11 Sodergren MH, Orihuela-Espina F, Clark J. et al. A hidden Markov model-based analysis framework using eye-tracking data to characterise re-orientation strategies in minimally invasive surgery. Cogn Process 2010; 11: 275-283
  • 12 Sodergren MH, Orihuela-Espina F, Clark J. et al. Evaluation of orientation strategies in laparoscopic cholecystecomy. Ann Surg 2010; 252: 1027-1036
  • 13 Sodergren MH, Orihuela-Espina F, Mountney P. et al. Orientation strategies in natural orifice translumenal endoscopic surgery. Ann Surg 2011; 254: 257-266
  • 14 van Doorn SC, Klanderman RB, Hazewinkel Y. et al. Adenoma detection rate varies greatly during colonscopy training. Gastrointest Endosc 2015; 82: 122-129
  • 15 Sodergren MH, Orihuela-Espina F, Froghi F. et al. Value of orientation training in laparoscopic cholecystectomy. Br J Surg 2011; 98: 1437-1445