Video clips compared with high-definition still images for characterization of colorectal neoplastic lesions: a randomized comparative prospective study

Abstract

Background and study aims Accurate real-time characterization of colorectal neoplastic lesions (CNLs) during colonoscopy is important for deciding appropriate treatment. No studies have evaluated whether still images or video clips are better for characterization. We compared histological predictions and size estimations of CNLs between two groups of gastroenterologists: one viewing still images and the other viewing video clips.

Materials and methods Participants were shown 20 CNLs as either 3–5 still images or a video clip. Three endoscopy experts obtained the images using high-definition white light and virtual chromoendoscopy without magnification. Stratified randomization was performed according to experience. For each lesion, participants assessed the size and histological subtype according to the CONECCT classification (hyperplastic polyp [IH], sessile serrated lesion [IS], adenoma [IIA], high-risk adenoma or superficial adenocarcinoma [IIC], or deeply invasive adenocarcinoma [III]). The correct histological status and size were defined by the pathology reports or combined criteria between histology and expert opinion for high-risk adenoma or superficial adenocarcinoma (CONECCT IIC).

Results 332 participants were randomized and 233 performed the characterization. Participants comprised 118 residents, 75 gastroenterologists, and 40 endoscopy experts; 47.6 % were shown still images and 52.4 % viewed video clips. There was no statistically significant difference between the two groups in histological prediction, our primary end point. However, the lesion size was better assessed using still images than video clips (P = 0.03).

Conclusions Video clips did not improve the histological prediction of CNLs compared with still images. Size was better assessed using still images.

Publication History

Received: 17 December 2020

Accepted: 14 March 2021

Article published online:
16 July 2021

• References

• 1 Fabritius M, Gonzalez J-M, Becq A. et al. A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program. Endosc Int Open 2019; 7: E1197-E1206
• 2 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 3 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 1155-1179
• 4 Oka S, Tanaka S, Kanao H. et al. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc 2009; 21 (Suppl. 01) S43-46
• 5 Kudo S, Tamura S, Nakajima T. et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
• 6 Uraoka T, Saito Y, Ikematsu H. et al. Sano’s capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc 2011; 23 (Suppl. 01) 112-115
• 7 Sano Y, Tanaka S, Kudo S-E. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
• 8 Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 2003; 58: S3-S43
• 9 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
• 10 IJspeert JEG, Bastiaansen BAJ, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
• 11 Livingstone M, Hubel D. Segregation of form, color, movement, and depth: anatomy, physiology, and perception. Science 1988; 240: 740-749
• 12 Rastogi A, Rao DS, Gupta N. et al. Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study. Gastrointest Endosc 2014; 79: 390-398
• 13 Kaz AM, Anwar A, O’Neill DR. et al. Use of a novel polyp “ruler snare” improves estimation of colon polyp size. Gastrointest Endosc 2016; 83: 812-816
• 14 Basford P, Brown J, Cooper S. et al. Endoscopic characterization of small colonic polyps: baseline performance of experienced endoscopists is no different to that of medical students. Endosc Int Open 2019; 7: E403-E411
• 15 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
• 16 Abu Dayyeh BK, Thosani N, Konda V. et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16
• 17 Chaptini L, Chaaya A, Depalma F. et al. Variation in polyp size estimation among endoscopists and impact on surveillance intervals. Gastrointest Endosc 2014; 80: 652-659
• 18 Sidhu M, Tate DJ, Desomer L. et al. The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon. Endoscopy 2018; 50: 684-692
• 19 Kudo S-E, Misawa M, Mori Y. et al. Artificial intelligence-assisted system improves endoscopic identification of colorectal neoplasms. Clin Gastroenterol Hepatol 2020; 18: 1874-1881