DEVELOPMENT AND VALIDATION OF THE GLOBAL POLYPECTOMY ASSESSMENT TOOL (GPAT) – A NOVEL ONLINE ASSESSMENT TOOL FOR ANY COLORECTAL POLYPECTOMY

Aims Colorectal polypectomy is commonly incomplete with high variability between endoscopists resulting in interval cancer or repeated procedures. Existing scores for polypectomy technique are cumbersome and difficult to use. We developed a user-friendly online assessment tool for any colorectal polypectomy: the Global Polypectomy Assessment Tool (GPAT). We aimed to validate GPAT with endoscopists of varied experience.

Methods GPAT was developed using statements derived from a Delphi-consensus between 11 internationally recognized polypectomy experts. The score has 20 items (Fig. 1), calculates a complexity and overall quality score. Evidence-based statements and explanatory videos enhance its reliability.

We included nine endoscopic-view videos of polypectomies (small/large polyps and hot/cold snare), recruited twelve international assessors via email (4 gastroenterologists, 3 trainee-gastroenterologists, 2 surgeons, and 3 medical students) and assessed GPAT’s validity through demonstrating the inter-rater agreement (Fleiss Kappa-value (κ)). The assessors watched a 2 minute 37 second GPAT-explaining video.

Fig. 1

Results We analyzed 108 GPAT-assessments of 12 assessors and demonstrated moderate agreement for the target population (the gastroenterologists and trainee-gastroenterologists) for both GPAT and the SMSA-score. Surgeons and medical students demonstrated fair agreement. ([Table 1]) Positive feedback was received regarding content and ease of use.

Table 1 Mean inter-observer agreement for all videos.

	SMSA (κ, 95%C.I.)	GPAT (κ, 95%C.I.)
Gastroenterologists	0.415 [0.095-0.735]	0.413 [0.348-0.478]
Trainees	0.518 [0.043-0.993]	0.460 [0.360-0.560]
All assessors	0.417 [0.327-0.506]	0.400 [0.379-0.422]

Conclusions This validation demonstrates standardized scoring of colorectal polypectomy video quality and difficulty with moderate inter-observer agreement amongst a varied panel of gastroenterologists and trainee-gastroenterologists with similar agreement found for the broadly used SMSA-score. With further study, GPAT may allow standardized assessment of trainees’ polypectomy competency with feedback on performance, demonstration of improvement over time and a method to accredit endoscopists in different levels of polypectomy.

Publication History

Article published online:
14 April 2022