Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2017; 23(34): 6281-6286
Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6281
Assessment of colon polyp morphology: Is education effective?
Jae Hyun Kim, Kyoung Sik Nam, Hye Jung Kwon, Youn Jung Choi, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
Jae Hyun Kim, Kyoung Sik Nam, Hye Jung Kwon, Youn Jung Choi, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park, Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-702, South Korea
Author contributions: Kim JH, Nam KS and Park SJ designed the study; Kim JH wrote the paper; Kwon HJ and Choi YJ performed colonoscopic examinations and recorded pictures of polyps; Nam KS created and edited the video clips; Jung K and Kim SE reviewed the video clips; Moon W and Park MI critically reviewed the manuscript for important intellectual content; Park SJ approved the manuscript; Kim JH and Nam KS contributed equally to this article.
Institutional review board statement: This study was approved by the Institutional Review Board of Kosin University Gospel Hospital (KUGH 2016-10-017).
Informed consent statement: Participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seun Ja Park, MD, Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-dong, Seo-gu, Busan 602-702, South Korea. parksj6406@daum.net
Telephone: +82-51-9905061 Fax: +82-51-9905055
Received: April 12, 2017
Peer-review started: April 17, 2017
First decision: June 7, 2017
Revised: June 9, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: September 14, 2017
Abstract
AIM

To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers.

METHODS

For purposes of the tests, we recorded colonoscopy video clips that included scenes visualizing the polyps. A total of 15 endoscopists and 15 nurses participated in the study. Participants watched 60 video clips of the polyp morphology scenes and then estimated polyp morphology (pre-test). After education for 20 min, participants performed a second test in which the order of 60 video clips was changed (post-test). To determine if the effectiveness of education was sustained, four months later, a third, follow-up test was performed with the same participants.

RESULTS

The overall Fleiss’ kappa value of the inter-observer agreement was 0.510 in the pre-test, 0.618 in the post-test, and 0.580 in the follow-up test. The overall diagnostic accuracy of the estimation for polyp morphology in the pre-, post-, and follow-up tests was 0.662, 0.797, and 0.761, respectively. After education, the inter-observer agreement and diagnostic accuracy of all participants improved. However, after four months, the inter-observer agreement and diagnostic accuracy of expert groups were markedly decreased, and those of beginner and nurse groups remained similar to pre-test levels.

CONCLUSION

The education program used in this study can improve inter-observer agreement and diagnostic accuracy in assessing the morphology of colon polyps; it is especially effective when first learning endoscopy.

Keywords: Colon polyp, Morphology, Education

Core tip: Paris classification is used worldwide in clinical practice to categorize the morphology of gastrointestinal polyps. However, few studies regarding the inter-observer variability associated with this classification have been reported. In this study, we identified that an education program could be helpful in improving inter-observer agreement and diagnostic accuracy when determining the morphology of colon polyps, and that the educational program was especially effective when first learning endoscopy. We suggest that daily practice of morphology assessment of colon polyps and the proper education of the Paris classification are essential in maintaining the quality of colonoscopic examination.