Validation of the GPAT – the Global Polypectomy Assessment Tool: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Abstract

Background Colorectal polypectomy is operator dependent, with variable rates of complete resection. The currently available assessment tools do not provide specific competency-based evaluation of provider technique. We aimed to validate the Global Polypectomy Assessment Tool (GPAT), a novel competency assessment tool for colorectal polypectomy.

Methods GPAT was derived from the ESGE Curriculum for Training in endoscopic mucosal resection in the colon. Members of the curriculum taskforce plus three invited trainees and three medical students (collectively: the assessors) anonymously assessed nine endoscopic-view only polypectomy videos. The primary end point was the correlation of the assessors’ GPAT scores with a consensus-derived reference GPAT score per video. Secondary end points were the assessors’ subjective impression versus their GPAT score and interobserver agreement among assessors’ GPAT scores.

Results 171 GPAT assessments by 19 assessors (consultant gastroenterologists [n = 10], trainee gastroenterologists [n = 4], consultant surgeons [n = 2], and medical students [n = 3]) were analyzed. Reference GPAT scores did not differ significantly from those of the assessors (73.1 % [95 %CI 64.6 %–81.6 %] vs. 69.3 % [95 %CI 64.9 %–81.2 %]; P = 0.47). There was moderate IOA in GPAT scores among gastroenterologists (intraclass correlation coefficient [ICC], 0.52 [moderate]) but not among nongastroenterologists (ICC 0.32 [poor]). GPAT correlated with assessors’ subjective impression of polypectomy quality (correlation coefficient 0.98 [95 %CI 0.90–1.00]; P < 0.001). Overall assessors’ qualitative usability scoring of GPAT was positive.

Conclusions GPAT allows standardized scoring of polypectomies, with moderate IOA among gastroenterologists and correlation with subjective impressions of polypectomy quality. GPAT could standardize assessment of trainee polypectomy competency offering structured feedback on performance.

• References

• 1 Winawer SJ, Zauber AG, Ho MN. et al. The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy. NEJM 1993; 329: 1977-1981
• 2 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
• 3 Sidhu M, Forbes N, Tate DJ. et al. A randomized controlled trial of cold snare polypectomy technique: technique matters more than snare wire diameter. Am J Gastroenterol 2022; 117: 100
• 4 Arimoto J, Chiba H, Higurashi T. et al. Risk factors for incomplete polyp resection after cold snare polypectomy. Int J Colorectal Dis 2019; 34: 1563-1569
• 5 Motchum L, Djinbachian R, Rahme E. et al. Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection. Endosc Int Open 2023; 11: E480-E489
• 6 Liu W, Gong J, Gu L. The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 2023; 38: 136
• 7 von Renteln D, Djinbachian R, Benard F. et al. Incomplete resection of 4–20 mm colorectal polyps when using cold snare and associated factors. Endoscopy 2023; 55: 929-937
• 8 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80.e1
• 9 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. CA Cancer J Clin 2021; 71: 209-249
• 10 Adler J, Toy D, Anderson JC. et al. Metachronous neoplasias arise in a higher proportion of colon segments from which large polyps were previously removed, and can be used to estimate incomplete resection of 10–20 mm colorectal polyps. Clin Gastroenterol Hepatol 2019; 17: 2277-2284
• 11 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 e12
• 12 Tollivoro TA, Jensen CD, Marks AR. et al. Index colonoscopy-related risk factors for postcolonoscopy colorectal cancers. Gastrointest Endosc 2019; 89: 168-176.e3
• 13 Samadder NJ, Curtin K, Tuohy TM. et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology 2014; 146: 950-960
• 14 Anderson R, Burr NE, Valori R. Causes of post-colonoscopy colorectal cancers based on world endoscopy organization system of analysis. Gastroenterology 2020; 158: 1287-1299.e2
• 15 Gupta S, Anderson J, Bhandari P. et al. Development and validation of a novel method for assessing competency in polypectomy: direct observation of polypectomy skills. Gastrointest Endosc 2011; 73: 1232-1239.e2
• 16 Gupta S, Bassett P, Man R. et al. Validation of a novel method for assessing competency in polypectomy. Gastrointest Endosc 2012; 75: 568-575
• 17 Tate DA, Argenziano ME, Anderson J. et al. Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55: 645-679
• 18 Okoli C, Pawlowski SD. The Delphi method as a research tool: an example, design considerations and applications. Inf Manag 2004; 42: 15-29
• 19 GPAT – The global polypectomy assessment tool. Accessed: 8 January 2025. www.gieqs.com/gpat
• 20 GPAT best practice video. Accessed: 8 January 2025. www.gieqs.com/videos/1215
• 21 Gupta S, Miskovic D, Bhandari P. et al. A novel method for determining the difficulty of colonoscopic polypectomy. Frontline Gastroenterol 2013; 4: 244-248
• 22 Sidhu M, Tate DJ, Desomer L. et al. Mo1662. SMSA-EMR score is a novel endoscopic risk assessment tool for predicting critical endoscopic mucosal resection outcomes. Gastrointest Endosc 2018; 87: AB467-AB468
• 23 GPAT showcase. Accessed: 8 January 2025. https://vimeo.com/showcase/10417029
• 24 Introduction to the study. Accessed: 8 January 2025. https://vimeo.com/562536661
• 25 Posit team. RStudio: Integrated Development Environment for R (2022). Accessed: 8 January 2025. https://posit.co
• 26 Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155-163
• 27 Miskovic D, Wyles SM, Carter F. et al. Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program. Surg Endosc 2011; 25: 1136-1142
• 28 Patel RV, Barsuk JH, Cohen ER. et al. Simulation-based training improves polypectomy skills among practicing endoscopists. Endosc Int Open 2021; 9: E1633-E1639
• 29 Patel SG, Duloy A, Kaltenbach T. et al. Development and validation of a video-based cold snare polypectomy assessment tool (with videos). Gastrointest Endosc 2019; 89: 1222-1230.e2
• 30 Crapé L, Debels L, Schoonjans C. et al. Development and validation of a novel score for the completeness of caecal intubation - the CCIS (completeness of caecal intubation score). Gastrointest Endosc 2022; 95: AB85-AB86
• 31 Jeyalingam T, Walsh CM. Video-based assessments: a promising step in improving polypectomy competency. Gastrointest Endosc 2019; 89: 1231-1233
• 32 Scaffidi MA, Grover SC, Carnahan H. et al. A prospective comparison of live and video-based assessments of colonoscopy performance. Gastrointest Endosc 2018; 87: 766-775
• 33 Patel K, Faiz O, Rutter M. et al. The impact of the introduction of formalised polypectomy assessment on training in the UK. Frontline Gastroenterol 2017; 8: 104-109
• 34 Anderson J, Lockett M. Training in therapeutic endoscopy: meeting present and future challenges. Frontline Gastroenterol 2019; 10: 135-140
• 35 Samuel A, Konopasky A, Schuwirth LWT. et al. Five principles for using educational theory: strategies for advancing health professions education research. Acad Med 2020; 95: 518-522
• 36 Hitchins CR, Metzner M, Edworthy J. et al. Non-technical skills and gastrointestinal endoscopy: a review of the literature. Frontline Gastroenterol 2018; 9: 129-134