Endoscopy 2018; 50(08): 779-789
DOI: 10.1055/s-0044-100791
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps[*]

Marietta Iacucci
 1  National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
 2  Division of Gastroenterology, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
 3  University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
 4  Gastroenterology, University of Calgary, Calgary, Canada
,
Cristina Trovato
 5  Division of Endoscopy, European Institute of Oncology, Milan, Italy
,
Marco Daperno
 6  Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
,
Oluseyi Akinola
 4  Gastroenterology, University of Calgary, Calgary, Canada
,
David Greenwald
 7  Division of Gastroenterology, Mount Sinai Hospital, New York, United States
,
Seth A. Gross
 8  Division of Gastroenterology, New York University Langone Medical Center, New York, United States
,
Arthur Hoffman
 9  Department of Internal Medicine II, Horst Schmidt Klinik, Wiesbaden, Germany
,
Jeffrey Lee
10  Medicine/Gastroenterology, University of California at San Francisco, San Francisco, United States
,
Brendan C. Lethebe
 4  Gastroenterology, University of Calgary, Calgary, Canada
,
Mark Lowerison
 4  Gastroenterology, University of Calgary, Calgary, Canada
,
Jennifer Nayor
11  Division of Gastroenterology, Brigham and Women Hospital, Harvard Medical School, Boston, United States
,
Helmut Neumann
12  First Medical Department, University Medical Center Mainz, Mainz, Germany
,
Timo Rath
13  Department of Medicine, University Hospital of Erlangen, Erlangen, Germany
,
Silvia Sanduleanu
14  Internal Medicine, Gastroenterology, and Hepatology, University Hospital Maastricht, Maastricht, Netherlands
,
Prateek Sharma
15  Gastroenterology, University of Kansas City, Kansas City, United States
,
Ralf Kiesslich
 9  Department of Internal Medicine II, Horst Schmidt Klinik, Wiesbaden, Germany
,
Subrata Ghosh
 1  National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
 2  Division of Gastroenterology, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
 3  University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
,
John R. Saltzman
11  Division of Gastroenterology, Brigham and Women Hospital, Harvard Medical School, Boston, United States
,
and the SIMPLE classification investigator team› Author Affiliations
Further Information

Publication History

submitted 15 April 2017

accepted after revision 02 December 2017

Publication Date:
23 March 2018 (eFirst)

Abstract

Background Prediction of histology of small polyps facilitates colonoscopic treatment. The aims of this study were: 1) to develop a simplified polyp classification, 2) to evaluate its performance in predicting polyp histology, and 3) to evaluate the reproducibility of the classification by trainees using multiplatform endoscopic systems.

Methods In phase 1, a new simplified endoscopic classification for polyps – Simplified Identification Method for Polyp Labeling during Endoscopy (SIMPLE) – was created, using the new I-SCAN OE system (Pentax, Tokyo, Japan), by eight international experts. In phase 2, the accuracy, level of confidence, and interobserver agreement to predict polyp histology before and after training, and univariable/multivariable analysis of the endoscopic features, were performed. In phase 3, the reproducibility of SIMPLE by trainees using different endoscopy platforms was evaluated.

Results Using the SIMPLE classification, the accuracy of experts in predicting polyps was 83 % (95 % confidence interval [CI] 77 % – 88 %) before and 94 % (95 %CI 89 % – 97 %) after training ( = 0.002). The sensitivity, specificity, positive predictive value, and negative predictive value after training were 97 %, 88 %, 95 %, and 91 %. The interobserver agreement of polyp diagnosis improved from 0.46 (95 %CI 0.30 – 0.64) before to 0.66 (95 %CI 0.48 – 0.82) after training. The trainees demonstrated that the SIMPLE classification is applicable across endoscopy platforms, with similar post-training accuracies for narrow-band imaging NBI classification (0.69; 95 %CI 0.64 – 0.73) and SIMPLE (0.71; 95 %CI 0.67 – 0.75).

Conclusions Using the I-SCAN OE system, the new SIMPLE classification demonstrated a high degree of accuracy for adenoma diagnosis, meeting the ASGE PIVI recommendations. We demonstrated that SIMPLE may be used with either I-SCAN OE or NBI.

* SIMPLE Classification Investigator Team: U. Shivaji and S. Smith, Division of Gastroenterology, University of Birmingham, UK; J. Ishtiaq, Division of Gastroenetrology, Royal stoke University Hospital, UK; S. Pelitari, Division of Gastroenterology, City Hospital NHS trust, Birmingham, UK; M. Kawidlak, Division of Gastroenterology, University Hospitals Coventry Warwickshire, UK; R. Khan, Liver Unit, University of Birmingham, UK; A. Karimmalik, Division of Gastroenterology, Good Hope Hospital, Birmingham, UK.


Table e3, Supplemental material 1, 2