This article is more than 5 years old. Information may no longer be current.
Video-based polypectomy tool efficiently assesses endoscopists’ skills
A team of researchers developed a new tool that can assess competence in cold snare polypectomy using a simplified, video-based approach, according to data published in Gastrointestinal Endoscopy.
Swati G. Patel, MD, of the University of Colorado Anschutz Medical Center, and colleagues wrote that the current standard polypectomy assessment tool — the Direct Observation of Polypectomy Skills (DOPyS) tool — is not entirely feasible for cold snare polypectomy because not all of its factors are applicable for cold snare, and it was not designed for video-based assessments.
“Application of the tool requires in-person, direct observation, which may not be practical,” they wrote. “Likely for these reasons, it is not routinely used in U.S. training programs to assess polypectomy competence.”
Researchers enlisted a group of expert endoscopists to develop and assess a new cold snare polypectomy assessment tool (CSPAT) by removing metrics from the DOPyS tool that were not applicable for cold snare and evaluating the remaining ones for their importance. If at least 85% of respondents graded a metric as “very important” or “important,” it was included in the CSPAT. Ultimately, developers incorporated 12 metrics into the tool, including polyp inspection, positioning, appropriate ensnarement of tissue to ensure a rim of normal tissue, tissue retrieval and postpolypectomy site inspection.
A group of 13 experts used the CSPAT to review 55 videos previously evaluated using the DOPyS tool, and researchers compared CSPAT scores with DOPyS scores to assess content validity.
The investigators wrote that there was a moderate degree of agreement in 10 metrics and a substantial degree of agreement in the remaining two. Four skills, appropriate positioning of the snare over the lesion as the snare is closed, ensuring a rim of normal tissue is resected around the polyp, anchoring the sheath of the snare several millimeters distal to the polyp, and directing the snare accurately over the lesion, were most strongly correlated with global competence scores, suggesting that experts see these skills as particularly important to competent polypectomy.
Additionally, researchers found a strong correlation between the mean of individual metrics 1 to 12 compared with the global competence assessment (Rho = 0.88; P < .001), as well as a moderate correlation between the average overall DOPyS score and the overall CSPAT competence score (Rho = 0.56; P < .001).
“Small polyps are the most commonly encountered polyps in clinical practice, and it is critical that endoscopists are competent at their removal,” Patel and colleagues concluded. “Efforts to assess and document polypectomy competency will be important in the transition to competency based medical education and to ensure all colonoscopists are effectively and safely performing polypectomy.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.