Abstract
Introduction: The virtual scale endoscope (VSE) is a newly introduced endoscope that helps endoscopists in measuring colorectal polyp size (CPS) during colonoscopy by displaying a virtual scale. This study aimed to determine the usefulness of the VSE for CPS measurement and the educational benefit of using VSE images to improve CPS estimation accuracy. Methods: This study included 42 colorectal polyps in 26 patients treated at Hiroshima University Hospital. In study 1, CPS measured using a VSE before endoscopic mucosal resection was compared with CPS measured on resected specimens, and the agreement between the two measurement methods was evaluated via Bland-Altman analysis. In study 2, 14 endoscopists (5 beginners, 5 intermediates, and 4 experts) took a pre-test to determine the size of 42 polyps. After the pre-test, a lecture on CPS measurement using VSE images was given. One month later, the endoscopists took a post-test to compare CPS accuracy before and after the lecture. Results: In study 1, Bland-Altman analysis revealed no fixed or proportional errors. The mean bias ±95% limits of agreement (±1.96 standard deviations) of the measurement error was −0.05 ± 0.21 mm, indicating that the agreement between two measurement methods was sufficient. In study 2, the accuracy of CPS measurement was significantly higher among beginners (59.5% vs. 26.7%, p < 0.01) and intermediates (65.2% vs. 44.3%, p < 0.05) in the post-test than in the pre-test. Conclusion: The VSE accurately measures CPS before resection, and its images are useful teaching tools for beginner and intermediate endoscopists.
Journal Section:
Research Article
References
1.
Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US multi-society task force on colorectal cancer. Gastroenterology. 2012 Sep;143(3):844–57.
2.
Hassan C, Quintero E, Dumonceau JM, Regula J, Brandão C, Chaussade S, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013 Oct;45(10):842–51.
3.
Gupta S, Lieberman D, Anderson JC, Burke CA, Dominitz JA, Kaltenbach T, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US multi-society task force on colorectal cancer. Gastroenterology. 2020 Mar;158(4):1131–53.e5.
4.
Vleugels J, Dekker E. Does polyp size matter. Endosc Int Open. 2017 Aug;5(8):E746–8.
5.
Ninomiya Y, Oka S, Tanaka S, Boda K, Yamashita K, Sumimoto K, et al. Clinical impact of surveillance colonoscopy using magnification without diminutive polyp removal. Dig Endosc. 2017 Nov;29(7):773–81.
6.
Uraoka T, Oka S, Ichihara S, Iwatate M, Tamai N, Kawamura T, et al. Endoscopic management of colorectal tumors less than 10 mm in size: current status and future perspectives in Japan from a questionnaire survey. Dig Endosc. 2018 Apr;30(Suppl 1):36–40.
7.
Chang CY, Chiu HM, Wang HP, Lee CT, Tai JJ, Tu CH, et al. An endoscopic training model to improve accuracy of colonic polyp size measurement. Int J Colorectal Dis. 2010 May;25(5):655–60.
8.
Shamsi N, Shaukat A, Halperin-Goldstein S, Colton J. Sizing of polyp illustrations differs by endoscopists’ gender and improves with a measurement reference. Eval Health Prof. 2020 Dec;43(4):270–3.
9.
Eichenseer PJ, Dhanekula R, Jakate S, Mobarhan S, Melson JE. Endoscopic mis-sizing of polyps changes colorectal cancer surveillance recommendations. Dis Colon Rectum. 2013 Mar;56(3):315–21.
10.
Anderson BW, Smyrk TC, Anderson KS, Mahoney DW, Devens ME, Sweetser SR, et al. Endoscopic overestimation of colorectal polyp size. Gastrointest Endosc. 2016 Jan;83(1):201–8.
11.
Utsumi T, Horimatsu T, Nishikawa Y, Teramoto A, Hirata D, Iwatate M, et al. Factors associated with inaccurate size estimation of colorectal polyps: a multicenter cross-sectional study. J Gastroenterol Hepatol. 2021 Aug;36(8):2224–9.
12.
Atalaia-Martins C, Marcos P, Leal C, Barbeiro S, Fernandes A, Santos A, et al. Variation between pathological measurement and endoscopically estimated size of colonic polyps. GE Port J Gastroenterol. 2019 May;26(3):163–8.
13.
Sakata S, McIvor F, Klein K, Stevenson ARL, Hewett DG. Measurement of polyp size at colonoscopy: a proof-of-concept simulation study to address technology bias. Gut. 2018 Feb;67(2):206–8.
14.
Hyun YS, Han DS, Bae JH, Park HS, Eun CS. Graduated injection needles and snares for polypectomy are useful for measuring colorectal polyp size. Dig Liver Dis. 2011 May;43(5):391–4.
15.
Kaz AM, Anwar A, O’Neill DR, Dominitz JA. Use of a novel polyp “ruler snare” improves estimation of colon polyp size. Gastrointest Endosc. 2016 Apr;83(4):812–6.
16.
Watanabe T, Kume K, Yoshikawa I, Harada M. Usefulness of a novel calibrated hood to determine indications for colon polypectomy: visual estimation of polyp size is not accurate. Int J Colorectal Dis. 2015 Jul;30(7):933–8.
17.
Goldstein O, Segol O, Gross SA, Jacob H, Siersema PD. Novel device for measuring polyp size: an ex vivo animal study. Gut. 2018 Oct;67(10):1755–6.
18.
Morales TG, Sampliner RE, Garewal HS, Fennerty MB, Aickin M. The difference in colon polyp size before and after removal. Gastrointest Endosc. 1996 Jan;43(1):25–8.
19.
Rex DK, Rabinovitz R. Variable interpretation of polyp size by using open forceps by experienced colonoscopists. Gastrointest Endosc. 2014 Mar;79(3):402–7.
20.
Gopalswamy N, Shenoy VN, Choudhry U, Markert RJ, Peace N, Bhutani MS, et al. Is in vivo measurement of size of polyps during colonoscopy accurate. Gastrointest Endosc. 1997 Dec;46(6):497–502.
21.
Yoshioka M, Sakaguchi Y, Utsunomiya D, Sonoda S, Tatsuta T, Ozawa S, et al. Virtual scale function of gastrointestinal endoscopy for accurate polyp size estimation in real-time: a preliminary study. J Biomed Opt. 2021 Sep;26(9):096002.
22.
Shimoda R, Akutagawa T, Tomonaga M, Murano T, Shinmura K, Yoshioka M, et al. Estimating colorectal polyp size with a virtual scale endoscope and visual estimation during colonoscopy: prospective, preliminary comparison of accuracy. Dig Endosc. 2022 Nov;34(7):1471–7.
23.
Hewett DG. Measurement of polyp size at colonoscopy: addressing human and technology bias. Dig Endosc. 2022 Nov;34(7):1478–80.
24.
Utsumi T, Horimatsu T, Nishikawa Y, Teramoto A, Hirata D, Iwatate M, et al. Short educational video to improve the accuracy of colorectal polyp size estimation: multicenter prospective study. Dig Endosc. 2020 Nov;32(7):1074–81.
25.
Giavarina D. Understanding bland altman analysis. Biochem Med. 2015;25(2):141–51.
26.
Rubio CA, Höög CM, Broström O, Gustavsson J, Karlsson M, Moritz P, et al. Assessing the size of polyp phantoms in tandem colonoscopies. Anticancer Res. 2009 May;29(5):1539–45.
27.
Chaptini L, Chaaya A, Depalma F, Hunter K, Peikin S, Laine L. Variation in polyp size estimation among endoscopists and impact on surveillance intervals. Gastrointest Endosc. 2014 Oct;80(4):652–9.
28.
Schoen RE, Gerber LD, Margulies C. The pathologic measurement of polyp size is preferable to the endoscopic estimate. Gastrointest Endosc. 1997 Dec;46(6):492–6.
29.
Altman DG, Bland JM. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983 Sep;32(3):307–17.
30.
Beukema KR, Simmering JA, Brusse-Keizer M, John S, Quispel R, Mensink PB. Factors influencing endoscopic estimation of colon polyp size in a colon model. Clin Endosc. 2022 Jul;55(4):540–8.
© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.
