Comparing size measurement of colorectal polyps using a novel virtual scale endoscope, endoscopic ruler or forceps: A preclinical randomized trial

Abstract

Background and study aims Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (biopsy forceps [BF] or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies. Our aim was to evaluate the performance of VSE when compared to ER and BF-based measurement.

Methods We conducted a preclinical randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and BF. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5-, 10-, and 20-mm thresholds.

Results A total of 360 measurements were performed. The relative accuracy of BF, ER, and VSE was 78.9 % (95 %CI = 76.2–81.5), 78.4 % (95 %CI = 76.0–80.8), and 82.7 % (95 %CI = 80.8–84.8). VSE had significantly higher accuracy compared to BF (P = 0.02) and ER (P = 0.006). VSE misclassified a lower percentage of polyps > 5 mm as ≤ 5 mm (9.4 %) compared to BF (15.7 %) and ER (20.9 %). VSE misclassified a lower percentage of ≥ 20 mm polyps as < 20 mm (8.3 %) compared with BF (66.7 %) and ER (75.0 %). Of polyps ≥10mm, 25.6 %, 25.5 %, and 22.5 % were misclassified as <10 mm with ER, BF, and VSE, respectively.

Conclusions VSE had significantly higher relative accuracy in measuring polyps compared to ER or BF assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds.

Publikationsverlauf

Eingereicht: 01. September 2022

Angenommen nach Revision: 29. Dezember 2022

Accepted Manuscript online:
02. Januar 2023

Artikel online veröffentlicht:
30. Januar 2023

• References

• 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. American Cancer Society 2021; 71: 209-249
• 2 He X, Hang D, Wu K. et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2020; 158: 852-861 e854
• 3 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for Follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1131-1153.e1135
• 4 Rex DK, Kahi C, OʼBrien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
• 5 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions; Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1095-1129
• 6 Shimoda R, Akutagawa T, Tomonaga M. et al. Estimating colorectal polyp size with a virtual scale endoscope and visual estimation during colonoscopy: Prospective, preliminary comparison of accuracy. Dig Endosc 2022; 34: 1471-1477
• 7 Kim JH, Park SJ, Lee JH. et al. Is forceps more useful than visualization for measurement of colon polyp size?. World J Gastroenterol 2016; 22: 3220-3226
• 8 Pochapin MB, Khan A, Rosenberg J. et al. S0520 the Napoleon: A pilot feasibility study of a small endoscopic ruler for accurate polyp measurement. Am J Gastroenterol 2020; 115: S259
• 9 Rex DK, Rabinovitz R. Variable interpretation of polyp size by using open forceps by experienced colonoscopists. Gastrointest Endosc 2014; 79: 402-407
• 10 Izzy M, Virk MA, Saund A. et al. Accuracy of endoscopistsʼ estimate of polyp size: A continuous dilemma. World J Gastrointest Endosc 2015; 7: 824-829
• 11 Turner JK, Wright M, Morgan M. et al. A prospective study of the accuracy and concordance between in-situ and postfixation measurements of colorectal polyp size and their potential impact upon surveillance. Eur J Gastroenterol Hepatol 2013; 25: 562-567
• 12 Masato Y, Yuichi S, Daisuke U. et al. Virtual scale function of gastrointestinal endoscopy for accurate polyp size estimation in real-time: a preliminary study. J Biomed Optics 2021; 26: 1-10
• 13 Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8: 18
• 14 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
• 15 Namburar S, von Renteln D, Damianos J. et al. Estimating the environmental impact of disposable endoscopic equipment and endoscopes. Gut 2022; 71: 1326
• 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.e501-502.e516
• 17 Abdelrahim M, Saiga H, Maeda N. et al. Automated sizing of colorectal polyps using computer vision. Gut 2022; 71: 7
• 18 Kwak MS, Cha JM, Jeon JW. et al. Artificial intelligence-based measurement outperforms current methods for colorectal polyp size measurement. Digest Endosc 2022; 34: 1188-1195
• 19 Taghiakbari M, Pohl H, Djinbachian R. et al. What size cutoff level should be used to implement optical polyp diagnosis?. Endoscopy 2022; 54: 1182-1190
• 20 Djinbachian R, Marchand E, Pohl H. et al. Optical diagnosis of colorectal polyps: a randomized controlled trial comparing endoscopic image-enhancing modalities. Gastrointest Endosc 2021; 93: 712-719 e711
• 21 Zarandi-Nowroozi M, Djinbachian R, von Renteln D. Polypectomy for diminutive and small colorectal polyps. Gastrointest Endosc Clin North Am 2022; 32: 241-257
• 22 Djinbachian R, Iratni R, Durand M. et al. Rates of incomplete resection of 1- to 20-mm colorectal polyps: a systematic review and meta-analysis. Gastroenterology 2020; 159: 904-914 e912