A SIMPLIFIED TABLE MIXING VALIDATED DIAGNOSTIC CRITERIA IS EFFECTIVE TO IMPROVE CHARACTERIZATION OF COLORECTAL LESIONS BY FELLOWS: THE CONECCT CLASSIFICATION

Aims:

Endoscopic characterization of colorectal neoplasia is a key point to choose in real time the best therapeutic option to treat effectively and safely each lesion. This characterization is based on 5 classifications, difficult to combine and to learn for non-experts. Thus, we mixed all the validated criteria in a single classification called CONECCT to facilitate prediction and therapeutic choice. This study aimed to evaluate CONECCT benefits in endoscopic characterization of colorectal neoplasia.

Methods:

It is a prospective multicenter study involving all French gastroenterology interns who participated to usual bi annual teaching session. Each student performed a pre-test with 20 colorectal neoplasia (High quality pictures with chromoendoscopy) with 2 questions for each about histology prediction and adequate treatment to propose. Then, they followed a 30 min teaching session about CONECCT and repeated a post-test with same 20 lesions in different order.

Results:

At the time of writing, we analyzed the first 88 participants including 86 students and 2 seniors (control group). Mean rate of good answers progressed from 54.1% at pre-test versus 73.6% at post-test (p < 0.0001) regardless of internship experience. Totally, 78 (88.6%) students progressed and mean progression per student between pre and post-test was 54.1%. Depending on histology, prediction results at pre and post-test were significantly improved (p < 0.001) with respectively 74.6 and 95.1% for hyperplastic polyps, 33.3 and 62.5% for SSL, 42.0 and 65.9% for adenomas, 46.6 and 61.4% for risky adenomas and superficial adenocarcinoma and 78.4 and 87.8% for deep invasive adenocarcinoma. After the teaching program, undertreated patients did not significantly reduced from 173 to 118 (p = 0.53) but over treated patients reduced significantly from 541 to 318 (p < 0.0001).

Conclusions:

CONECCT classification teaching is effective to improve histology prediction and treatment choice regardless of lesion histology in gastroenterology interns.