Quality of upper GI endoscopy: a prospective cohort study on impact of endoscopist education

Impact of a training intervention on upper gastrointestinal endoscopy quality over time: Multicenter comparative cohort study

Background and study aims

The European Society of Gastrointestinal Endoscopy (ESGE) and British Society of Gastroenterology (BSG) formulated performance measures to improve the detection rate for upper gastrointestinal (UGI) endoscopy. We aimed to assess adherence to and impact of training on adherence to performance measures for UGI endoscopy.

Methods

In this multicenter, prospective, cohort study, endoscopists at three centers underwent 1-hour face-to-face training based on ESGE and BSG procedure performance measures (≥ 7-minute inspection time; photodocumentation of ≥ 10 anatomical landmarks + abnormalities; standardized terminology; biopsy protocols). A self-developed quality assessment score was used to assess diagnostic UGI endoscopies before (control group) and after (intervention group) training. The primary endpoint was improvement in overall quality score (percentage of the maximum score).

Results

Of 1,733 consecutive UGI endoscopies, 570 were eligible for inclusion (mean patient age 60 years [standard deviation 15]; male 47%): 285 in the control group and 285 in the intervention group. Overall quality score increased from 60% before to 67% after the training intervention (difference 7%, 95% confidence interval [CI] 5-10, P < 0.001). Male patients (3.2%, 95% CI 0.7-5.7), alarming features (-3.1%, 95% CI -5.6 to -0.5), and endoscopist age (-0.4% increment per year, 95% CI -0.8 to -0.1) were associated with higher quality scores.

Conclusions

Adherence to the ESGE and BSG procedure performance measures for UGI endoscopy persistently increased after a 1-hour face-to-face training intervention, suggesting that a simple training intervention tool can improve the quality of UGI endoscopy and potentially could prevent missed lesions.

Implementing educational interventions and key performance measures sustains quality of endoscopic assessment in patients with Barrett's esophagus

Background and study aims

Quality metrics for Barrett's esophagus (BE) are anticipated to improve outcomes for patients through earlier detection of neoplasia. The European Society of Gastrointestinal Endoscopy has developed guidelines to homogenize endoscopic quality in BE. Our study aimed to assess the impact of recommended key performance measures (KPMs) and their sustainability.

Patients and methods

A single-center, retrospective study (Phase 1) was conducted over 8 weeks. The KPMs assessed were: 1) pre-procedure metrics including indication, consent, safety checklist (target of 100%); and 2) Prague classification, Seattle protocol, or targeted biopsies, inspection time of 1 minute per cm, advanced imaging and surveillance recommendations (target of 90%). Following baseline analysis, multimodal educational interventions were implemented and repeated at 6-month intervals. Repeat analysis was performed at 6 months and 1 and 3 years (Phases 2, 3 and 4 respectively).

Results

In Phase 1, 39 patients with BE underwent endoscopy. Phase 2 evaluated 40 patients with BE. Phase 3 analyzed 59 patients with BE, and Phase 4 identified 34 patients with BE. Pre-procedure metrics were met in 100% of patients across the 3-year period. Baseline analysis displayed suboptimal performance at 45% to 75% for all other KPMs. However, after regular multimodal educational interventions, quality standards significantly improved and were able to be maintained over all phases, achieving pre-set targets of >9 0% for all KPMs except one.

Conclusions

Sustaining improvements in quality metrics in Barrett's endoscopy is important. Our study suggests that regular, replicable education interventions have a positive effect and allow sustained long-term improvements in quality metrics.

Unsedated colonoscopy utilizing virtual reality distraction: a pilot-controlled study

BACKGROUND

Sedation increases colonoscopy risks and prolongs recovery time. We examined whether virtual reality (VR) can substitute for sedation. The primary outcome was the overall satisfaction of patients who underwent colonoscopy with VR headset compared with patients who underwent standard sedation. Pain during the procedure, polyp detection rate (PDR), colonoscopy duration, post-colonoscopy adverse events, post-colonoscopy recovery, time-to-return to daily functions, and turnaround time at the endoscopy unit were secondary outcomes.

METHODS

The study was approved by Sheba Medical Center's ethics committee IRB number 21-8177-SMC. Sixty patients were sequentially enrolled in a 1:1 ratio to either standard sedated colonoscopy or VR-unsedated procedure, and all patients signed a written informed consent. 28/30 patients successfully completed the colonoscopy using VR headset. Overall satisfaction score was comparable between the groups.

RESULTS

There was no difference between VR and controls in colonoscopy duration, or PDR. VR patients had numerically lower rate of post-colonoscopy adverse events than controls. The proportion of VR patients who reported resuming daily activities on the day of the procedure was significantly higher than in the control group. The VR group patients spent significantly less time in the hospital compared to the control group.

CONCLUSIONS

VR technology can provide adequate substitution for sedation for most patients undergoing colonoscopy and offers comparable patient satisfaction and faster return to daily activities.

Development and validation of a novel colonoscopy withdrawal time indicator based on YOLOv5

BACKGROUND AND AIM

The study aims to introduce a novel indicator, effective withdrawal time (WTS), which measures the time spent actively searching for suspicious lesions during colonoscopy and to compare WTS and the conventional withdrawal time (WT).

METHODS

Colonoscopy video data from 472 patients across two hospitals were retrospectively analyzed. WTS was computed through a combination of artificial intelligence (AI) and manual verification. The results obtained through WTS were compared with those generated by the AI system. Patients were categorized into four groups based on the presence of polyps and whether resections or biopsies were performed. Bland Altman plots were utilized to compare AI-computed WTS with manually verified WTS. Scatterplots were used to illustrate WTS within the four groups, among different hospitals, and across various physicians. A parallel box plot was employed to depict the proportions of WTS relative to WT within each of the four groups.

RESULTS

The study included 472 patients, with a median age of 55 years, and 57.8% were male. A significant correlation with manually verified WTS (r = 0.918) was observed in AI-computed WTS. Significant differences in WTS/WT among the four groups were revealed by the parallel box plot (P < 0.001). The group with no detected polyps had the highest WTS/WT, with a median of 0.69 (interquartile range: 0.40, 0.97). WTS patterns were found to be varied between the two hospitals and among senior and junior physicians.

CONCLUSIONS

A promising alternative to traditional WT for quality control and training assessment in colonoscopy is offered by AI-assisted computation of WTS.