Advanced Imaging Endoscopy: Developing the Better Endoscopist

Abstract

Purpose: Optical imaging techniques such as narrow band imaging (NBI) have demonstrated a promising in-vivo modality that enables one to predict adenomatous polyps. Previous studies have demonstrated that in experienced hands, up to 80% of colorectal polyps were accurately identified. Other studies demonstrated training gastroenterologist and physicians learning NBI to differentiate hyperplastic polyps from adenomatous polyps can result in an increased accuracy from 60% to 94%. We propose that advanced imaging endoscopy may provide the endoscopist-in-training a foundation for in-vivo polyp evaluation and ultimately improve adenoma detection. This study evaluated the ability of one first year fellow, after six months of training, to accurately predict adenomas based upon digital chromoendoscopy and Kudo pit pattern. The endoscopist performed 48 colonoscopies during his first 6 months of training. Methods: The study utilized the narrow band imaging capabilities of the Olympus high definition CF-H180AL, PCF-H180AL and the I-Scan of the Pentax EC3890Li endoscopes, respectively. Endoscopies were conducted in white light and then polyps were evaluated in blue light with Kudo score documentation suggesting hyperplastic or adenomatous polyps on the endoscopy report. Subsequently, pathology findings were retrospectively evaluated by chart review. Results: 19 patients were evaluated and a total of 22 polyps were removed. The most common Kudo classification was type II (41%). Overall accuracy of predicting adenomas was 68% (P=0.307). Conclusion: The data in this study was not statistically significant, but this raises the important question about the role of advanced imaging techniques during endoscopic training and how this may be utilized to monitor a trainee's performance progress. We propose that larger studies monitoring digital chromoendoscopy and prediction of adenomatous polyps may provide an objective measure of a trainee's progress and ultimately improve adenoma detection rates for newly trained gastroenterologists.