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Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes
Meghana Raghavendra1, David G Hewett, Douglas K Rex
1Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Background:
Colonoscopy with narrow-band imaging can allow real-time determination of polyp histology.
Objective:
To determine whether physicians with varying levels of experience can learn and apply endoscopic criteria to distinguish between adenomas and hyperplastic polyps.
Design:
Prospective observational study.
Setting:
University teaching hospital.
Participants:
This study involved 37 physicians (medical residents, N = 12; gastroenterology fellows, N = 12; and gastroenterology faculty, N = 13).
Intervention:
Small-group, 20-minute, didactic teaching sessions in which the endoscopic criteria for determining polyp histology by using narrow-band imaging were described and demonstrated.
Main Outcome Measurements:
Learning outcomes were evaluated by using written pretests and posttests in which participants scored pathologically verified, high-definition polyp photographs as adenomas or hyperplastic polyps.
Results:
The mean overall scores increased significantly from 47.6% correct on the pretest to 90.8% correct on the posttest (P = .0001). The overall mean percentage of responses answered don't know was significantly lower on the posttest (0.6%) compared with the pretest (20.5%, P < .0001). After training, the level of agreement was substantial (kappa = 0.69 for all participants, kappa = 0.79 for fellows).
Limitations:
Our study did not assess for sustained improvement with time or in vivo accuracy of histological prediction during live colonoscopy. Further validation in a sample of community physicians is required.
Conclusion:
A short, didactic teaching session can achieve high accuracy and good interobserver agreement in the use of narrow-band imaging for determining the histology of colorectal polyps.
