Published online Mar 14, 2019. doi: 10.3748/wjg.v25.i10.1278
Peer-review started: January 2, 2019
First decision: January 30, 2019
Revised: February 20, 2019
Accepted: February 22, 2019
Article in press: February 23, 2019
Published online: March 14, 2019
The implementation of optical diagnosis (OD) of diminutive colorectal lesions in clinical practice has been hampered by differences in performance between community and academic settings. One possible cause is the lack of a standardized learning tool. Since the factors related to better learning are not well described, strong evidence upon which a consistent learning tool could be designed is lacking. We hypothesized that a self-designed learning program may be enough to achieve competency in OD of diminutive lesions of the colon.
To assess the accuracy of OD of diminutive lesions in real colonoscopies after application of a self-administered learning program.
This was a single-endoscopist prospective pilot study, in which an experienced endoscopist followed a self-designed, self-administered learning program in OD of colorectal lesions. An assessment phase divided in two halves with a 6-mo period in between without performance of OD was developed in a population-based colorectal cancer screening program. The accomplishment of the Preservation and Incorporation of Valuable Endoscopic Innovations criteria and performance measures were calculated overall and in the two halves of the assessment phase, assessing their response to the 6-mo stopping period. The evolution of performance through blocks of 50 lesions was also assessed.
Overall, 152 patients and 522 lesions (≤ 5 mm: 399, and 6-9 mm: 123) were included. The negative predictive value for the OD of adenoma in rectosigmoid lesions diagnosed with high confidence was 91.7% [95% confidence interval (CI): 87.3-96.6]. The proportion of agreement on surveillance interval between OD and pathological diagnosis was higher than 95%. Overall accuracy for diminutive lesions diagnosed with high confidence was 89.5% (95%CI: 86.3-92.7). The overall accuracy of OD was similar in the two halves of the assessment phase [90.1 (95%CI: 85.6-94.7) vs 88.2 (95%CI: 87.9-95.9)]. All the other performance parameters were also equivalent, except for specificity. Specificity, negative predictive value and accuracy were the parameters most affected by the stopping period between the two halves. Upon analyzing trends on blocks of 50 lesions, an improvement on sensitivity (P = 0.02) was detected only in the first half and an improvement on accuracy (P = 0.01) was detected only in the second half.
A self-administered learning program is sufficient to achieve expert-level OD. To maintain performance, continuous practice is needed, with a refresher course following any long non-practice period.
Core tip: The learning process for optical diagnosis (OD) of diminutive colorectal polyps is not standardized, and this may influence the described differences in OD performance between community and academic settings. Our study shows that an individual following a self-designed and self-administered learning program is able to reach the expert level of OD performance completely fulfilling the criteria of Preservation and Incorporation of Valuable Endoscopic Innovations. However, continuous practice is needed to maintain performance and, if a non-practice period is expected, a refresher course is needed to avoid a significant drop in performance parameters.