Photodocumentation of Large Colorectal Polyps: An Audit of Image Quality

Numerous guidelines recommend photodocumentation (PD) of large colorectal polyps ≥10 mm (LP) preresection relative to an open snare or forceps, and suggests postresection PD of the clear resection base. However, no quality metrics have been proposed. We recently reported that preresection and postresection PD occurred in 82% and 52% of 1693 resected LPs, respectively; however, the quality of PD was not ascertained.

To assess the quality of preresection and postresection PD of LPs based on consensus definitions.

Images of LPs resected between 2016 and 2021 were reviewed by 3 gastroenterologists and 1 fellow for assessment of (1) high-quality preresection PD (enough polyp visualized to estimate size), (2) presence of a tool relative to the LP, (3) estimated polyp size, and (4) high-quality postresection PD (clean base without visible polyp tissue). Confidence levels in PD quality assessment and estimated size were provided. Agreement on size was assessed using free-marginal kappa.

One hundred ninety-nine LPs with both preresection and postresection images were included. Reviewers' assessment of high-quality preresection PD ranged from 49% to 82% and 51% to 70% for high-quality postresection PD. One percent of preresection images demonstrated an open snare or forceps relative to the LP. Only 74% to 89% of polyps were estimated by reviewers to be ≥10 mm [Kappa=0.66 (95% CI: 0.48-0.64)]. High-level confidence in PD quality and size assessment was lowest in the fellow compared with established gastroenterologists.

Although guidelines recommend PD of LPs preresection and postresection, the quality of PD appears suboptimal. Quality standards in LP PD should be considered and the impact of high-quality PD on patient outcomes should be studied.