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  • Title: Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes.
    Author: Raghavendra M, Hewett DG, Rex DK.
    Journal: Gastrointest Endosc; 2010 Sep; 72(3):572-6. PubMed ID: 20561618.
    Abstract:
    BACKGROUND: Colonoscopy with narrow-band imaging can allow real-time determination of polyp histology. OBJECTIVE: To determine whether physicians with varying levels of experience can learn and apply endoscopic criteria to distinguish between adenomas and hyperplastic polyps. DESIGN: Prospective observational study. SETTING: University teaching hospital. PARTICIPANTS: This study involved 37 physicians (medical residents, N = 12; gastroenterology fellows, N = 12; and gastroenterology faculty, N = 13). INTERVENTION: Small-group, 20-minute, didactic teaching sessions in which the endoscopic criteria for determining polyp histology by using narrow-band imaging were described and demonstrated. MAIN OUTCOME MEASUREMENTS: Learning outcomes were evaluated by using written pretests and posttests in which participants scored pathologically verified, high-definition polyp photographs as adenomas or hyperplastic polyps. RESULTS: The mean overall scores increased significantly from 47.6% correct on the pretest to 90.8% correct on the posttest (P = .0001). The overall mean percentage of responses answered don't know was significantly lower on the posttest (0.6%) compared with the pretest (20.5%, P < .0001). After training, the level of agreement was substantial (kappa = 0.69 for all participants, kappa = 0.79 for fellows). LIMITATIONS: Our study did not assess for sustained improvement with time or in vivo accuracy of histological prediction during live colonoscopy. Further validation in a sample of community physicians is required. CONCLUSION: A short, didactic teaching session can achieve high accuracy and good interobserver agreement in the use of narrow-band imaging for determining the histology of colorectal polyps.
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