Original ResearchClinical—Alimentary TractReal-Time Optical Biopsy of Colon Polyps With Narrow Band Imaging in Community Practice Does Not Yet Meet Key Thresholds for Clinical Decisions
Section snippets
Study Site, Participants, Endoscopic Equipment, and General Study Design
Gastroenterologists from a single-specialty practice in Ann Arbor, Michigan, participated in the study. A research coordinator in Ann Arbor entered data into a REDCap (Vanderbilt University) database designed and administered at a data coordination and analysis center at Stanford University (Stanford, CA).
The institutional review boards of St Joseph Mercy Hospital in Ann Arbor, Michigan, and Stanford University approved the study. All authors had access to the study data and reviewed and
Participant Demographics, Study Colonoscopies, and Polyps
Fourteen participants enrolled and completed the ex vivo study phase, and 12 of them entered the in vivo study phase (Table 1). The in vivo study phase included a total of 1673 study colonoscopies and 2596 study polyps (1858 diminutive, 547 small, 177 large, 14 size missing), with adenomas accounting for 62% of diminutive, 72% of small, and 78% of large study polyps (Table 1).
Ex Vivo Pretest and Posttest
Posttest results were missing for 1 subject, and pretest results were missing for 2 subjects. Test scores improved for
Discussion
We assessed whether the high performance levels in optical diagnosis of polyp histology by experts using NBI can be replicated in real-time practice by community gastroenterologists using commercially available equipment. Ex vivo, after completion of a computerized self-learning module, 12 of 13 participants scored >90% correct on a photograph-based posttest. In vivo, 3 of 12 participants achieved accuracy ≥90% in assessing diminutive polyp histology. Learning curves showed considerable
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This article has an accompanying continuing medical education activity on page e17. Learning Objective: Upon completion of this CME activity, successful learners will be able to distinguish between the NBI features of adenomatous and non-adenomatous polyps, identify the recommended ASGE PIVI performance thresholds, and demonstrate knowledge of the current performance levels in NBI optical biopsy in routine practice.
Conflicts of interest The authors disclose the following: D. K. Rex has received research support and serves on the speaker's bureau for Olympus Corp. The remaining authors disclose no conflicts.
Funding Supported by a grant from the Division of Gastroenterology at Stanford University School of Medicine.