Colonoscopy Peer Review Utilizing Automated Video Capture

Abstract

Purpose: Colonoscopy is the screening modality of choice for detecting early colorectal cancer in the United States. Several retrospective reports show that colorectal cancers may appear within 3 years of a colonoscopy, suggesting some polyps or cancers are missed. Despite these findings, no standardized, validated method exists to objectively evaluate the skill set of an endoscopist. Aim: to evaluate an anonymous, automated video capture system used in conjunction with novel software to facilitate peer review of endoscopic performance, and to see if higher quality exams correlate with withdrawal time. Methods: Existing infrastructure and software were used to capture entire colonoscopies which were then stored as digital video files and reviewed anonymously. Video colonoscopy files were randomly obtained from 2 endoscopy suites at Mayo Clinic-Rochester over the course of 4 days in 2007. Three endoscopists with varied endoscopic experience (1 fellow, 1 junior staff and 1 senior staff) reviewed a set of 24 anonymous video colonoscopies, and provided feedback via a graphical user interface. The 3 reviewers were asked to assign numerical scores on several parameters: adequacy of colonic mucosal visualization including the proximal side of haustral folds, flexures, rectal valves and the ileocecal valve (0-100), adequacy of removal of fluid/feces during exam (0-10), and adequacy of luminal distention during exam (0-10). Additionally, reviewers identified key time points during each colonoscopy and a withdrawal time was calculated. Results: The panel of 3 individual reviewers demonstrated agreement when asked to evaluate 24 random colonoscopy video files of varied quality. Specifically, the intraobserver agreement for the visualization score (0-100) was good, reflected by a disagreement range of 19 ± 13 (Mean+SD). Similarly, scores for adequacy of fluid/feces removal (0-10) and adequacy of luminal distention (0-10), showed good agreement also reflected by low intra-observer disagreement; range 2.0 ± 1.3, and 2.1 ± 1.5 (Mean+SD), respectively. There was no relationship between visualization score and withdrawal time for each reviewed case: least squares analysis showed no correlation between the two (R2 = 0.04). Conclusion: Our results show that a standardized, anonymous method utilizing video capture and new software technology allows effective and consistent peer review of individual colonoscopies. The close agreement among reviewers suggests that this peer review method is independent of the evaluator's experience. Therefore, our method can be used to ensure that an endoscopist meets a minimal standard of quality, assessed in an anonymous and reproducible fashion. Our results question the utility of withdrawal time as a standard for quality. Disclosure: PC de Groen - stock in EndoMetric J Wong - stock in EndoMetric W Tavanapong - stock in EndoMetric J Oh - stock in EndoMetric.