Introduction: There is no conclusive evidence that routine video recording of endoscopic procedures such as colonoscopy improves quality of colonoscopy: at least 1 study suggests a significant improvement in quality [AJG 2010;105:2312], whereas another study shows that 4 out of 5 cancers were missed during colonoscopy with video recording [AJR 2007;189:672]. We aim to determine whether endoscopist awareness of routine, anonymous recording of the entire procedure improves quality of colonoscopy. Methods: Seven endoscopy rooms were equipped with real-time video capture workstations able to provide real-time feedback [AJG 2012;107:S596]. The workstations run real-time software Endoscopic Multimedia Information System (EMIS) 24 hours per day, able to determine when an endoscope enters or leaves a patient and in fully automated fashion record as video file the entire image stream obtained during the inside-the-patient part of the procedure. We randomized the endoscopy rooms to either no feedback (Control) or feedback (FB); FB consisted of the message EMIS ON in the right lower corner before the endoscope entered a patient and EMIS INSIDE during the inside-the-patient part of the procedure. In addition, at the end of insertion the RN in the room was asked to activate the FB system by pushing a keypad button that resulted in the message WITHDRAWAL. No other type of feedback was provided; all recording was anonymous. All video files where manually annotated for start, beginning of withdrawal phase, and end of procedure images, and then analyzed using an automated pipeline for a large number of features associated with quality [Gastroenterol 2014;146:S728]. Results: A total of 2,407 video files were obtained; 1,202 of patients in the Control group and 1,205 of patients in the FB group. Within the FB group, the RNs did not activate EMIS in 510 patients (FBminimal) and activated EMIS in 695 patients (FB-full). Clear withdrawal time (mean±SD 9.2±5.9, 9.4±6.0, 9.2±6.5 min), removal of remaining debris (BBPS -.22±0.49, -.24±.42, -.24±.68), circumferential withdrawal score (10.1±6.3, 10.2±6.5, 10.7±6.3) and an overall score of quality as previously described (3.1±2.2, 3.0±2.2, 3.2±2.3) were identical among the 3 groups (Control, FB-minimal; FB-full, respectively; p≥0.12 for all evaluations). Within each group there was large variation in measured quality, large but similar SDs. Endoscopists were informed that all video recording was anonymous and had no implications for the endoscopist. Conclusion: Routine, anonymous video recording does not improve quality of colonoscopy. Future studies need to assess whether identifiable real-time video recording and assessment of quality with FB, linked to adenoma detection rate, can improve quality of colonoscopy. Disclosure - Drs. de Groen, Tavanapong, Wong and Oh - intellectual property rights and royalties less than $5000 per year. Drs. Tavanapong, Wong and Oh - employees of EndoMetric.
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