Endoscopy 2018; 50(07): 701-707
DOI: 10.1055/s-0044-101026
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy

Mariam Lami
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Harsimrat Singh
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
James H. Dilley
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Hajra Ashraf
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Matthew Edmondon
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Felipe Orihuela-Espina
Instituto Nacional de Astrofisica, Optica y Electronica (INAOE), Mexico
,
Jonathan Hoare
Department of Interventional Endoscopy, St. Mary’s Hospital, Imperial College, London, United Kingdom
,
Ara Darzi
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
,
Mikael H. Sodergren
Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
› Author Affiliations
Further Information

Publication History

submitted 07 September 2017

accepted after revision 04 December 2017

Publication Date:
07 February 2018 (eFirst)

Abstract

Background The adenoma detection rate (ADR) is an important quality indicator in colonoscopy. The aim of this study was to evaluate the changes in visual gaze patterns (VGPs) with increasing polyp detection rate (PDR), a surrogate marker of ADR.

Methods 18 endoscopists participated in the study. VGPs were measured using eye-tracking technology during the withdrawal phase of colonoscopy. VGPs were characterized using two analyses – screen and anatomy. Eye-tracking parameters were used to characterize performance, which was further substantiated using hidden Markov model (HMM) analysis.

Results Subjects with higher PDRs spent more time viewing the outer ring of the 3 × 3 grid for both analyses (screen-based: r = 0.56, P = 0.02; anatomy: r = 0.62, P < 0.01). Fixation distribution to the “bottom U” of the screen in screen-based analysis was positively correlated with PDR (r = 0.62, P = 0.01). HMM demarcated the VGPs into three PDR groups.

Conclusion This study defined distinct VGPs that are associated with expert behavior. These data may allow introduction of visual gaze training within structured training programs, and have implications for adoption in higher-level assessment.