A high-quality colonoscopy requires a thorough mucosal inspection to identify neoplastic polyps. Adenoma detection rate (ADR) and withdrawal time (WT) may be difficult to measure, are subject to ‘gaming,’ and do not provide actionable feedback for improvement. A standardized scale to assess colonoscopy inspection quality (CIQ) provides targeted feedback, but is time-consuming for raters. The aim of this study is to determine whether colonoscopy-naive (“novice”) rater assessments of CIQ correlate with expert rater assessments, and with standard metrics of colonoscopy quality. We conducted a prospective study of attending endoscopists (each performing ≥100 annual screening colonoscopies) at a single academic medical center. Over a 6-week period, we recorded >28 screening/surveillance colonoscopies per endoscopist. We excluded colonoscopies that were incomplete, had an inadequate preparation, or were performed in high-risk patients (IBD, polyposis, colon cancer history). Six experienced U.S. endoscopists acted as blinded expert raters and 3 internal medicine residents acted as novice raters. All novice raters underwent a 60-minute training session on CIQ, in which video examples of variable inspection quality were studied. Six randomly selected videos per endoscopist were reviewed by expert (1 video per endoscopist) and novice (2 videos per endoscopist) raters. An additional 7 videos with WT >10 minutes and varying inspection quality (previously assessed by experts) were reviewed by all novice raters. CIQ was graded using an established scale (Rex, GIE, 2000) for fold examination, colon distension, and cleaning by segment (maximum score of 75). Scores per endoscopist were averaged and the median average reported (“median”). We utilized 12-month historical data to calculate screening colonoscopy (age 50—75) ADR and normal (no biopsy/polypectomy) WT. Novices and experts reviewed 102 colonoscopies by 17 endoscopists with a median ADR of 40% (interquartile range: 31%—47%). Novice and expert ratings for total CIQ (Spearman r=0.92, P < .001) and the individual CIQ components of fold examination (r=0.84, P < .001), cleaning (r=0.87, P < .001), and colon distention (r=0.68, P = .003) all significantly correlated (Table 1; Figure 1). Novice endoscopic CIQ scores significantly correlated with ADR (r=0.59, P = .01) and WT (r=0.61, P = .01). In a sensitivity analysis of CIQ rating independent of WT, novice and expert ratings significantly correlated (r=0.79, P = .03). Novice CIQ scores correlate highly with expert rater CIQ scores and colonoscopy metrics. These data suggest that novice raters can reliably and feasibly rate CIQ. Evaluation of CIQ by novice raters may augment current colonoscopy quality improvement programs by providing objective and actionable feedback to endoscopists without a need to rely on expert reviewers.Table 1Correlation of CIQ Scores Between Novice and Expert RatersNovice RatersExpert RatersSpearman CorrelationCIQ Score, Total, median (IQR)∗Maximum 75;51.7 (44.0—55.4)50.1 (44.1—59.0)0.92, P < .001 CIQ Score, Fold ExaminationMaximum 25;17.5 (15.4—19.0)14.9 (15.8—20.8)0.84, P < .001 CIQ Score, CleaningMaximum 25;16.0 (11.4—18.3)18.6 (16.4—21.7)0.87, P < .001 CIQ Score, Colon DistentionMaximum 25;17.7 (16.6—19.2)17.1 (15.8—20.8)0.68, P = .003CIQ Score, Proximal Colon OnlyˆMaximum 45;31.0 (26.8—34.2)30.1 (27.2—36.2)0.91, P < .001CIQ Score, Left Colon OnlyMaximum 30.19.5 (16.8—21.7)19.6 (16.9—22.8)0.84, P < .001∗ Maximum 75;∗∗ Maximum 25;ˆ Maximum 45;ˆˆ Maximum 30. Open table in a new tab