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Original Article

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Real-Time Optical Diagnosis of Colorectal Polyps in the Routine Clinical Practice Using the NICE and WASP Classifications in a Nonacademic Setting

Castela J.a · Mão de Ferro S.a · Rosa I.a · Lage P.a · Ferreira S.a · Pereira Silva J.a · Cortez Pinto J.a · Vale Rodrigues R.a · Moleiro J.a · Claro I.a · Esteves S.b · Dias Pereira A.a

Author affiliations

aDepartment of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
bClinical Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal

Corresponding Author

Dr. Joana Castela

Department of Gastroenterology

Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E.

Rua Prof. Lima Basto, PT–1099-023 Lisbon (Portugal)

E-Mail joanarocastela@gmail.com

Keywords: Colorectal polypsNarrow-band imagingOptical diagnosisLearning effect

Related Articles for ""
GE Port J Gastroenterol 2019;26:314–323
https://doi.org/10.1159/000495258

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Abstract

Background: Narrow-band imaging (NBI) allows “in vivo” classification of colorectal polyps. Objectives: We evaluated the optical diagnosis by nonexpert community-based endoscopists in routine clinical practice, the impact of training, and whether the endoscopists could achieve the threshold for the “do not resect” policy. Methods: This was an observational study performed in two periods (P1 and P2). Endoscopists had no prior experience in NBI in P1 and applied the technique on a daily basis for 1 year before participation in P2. Lesions were classified by applying the NBI International Colorectal Endoscopic (NICE) and Workgroup serrAted polypS and Polyposis (WASP) classifications, simultaneously. Results: A total of 290 polyps were analyzed. The overall accuracy of optical diagnosis was 0.75 (95% CI 0.68–0.81) in P1, with an increase to 0.82 (95% CI 0.73–0.89) in P2 (p = 0.260). The accuracy of the NICE/WASP classifications to differentiate adenomatous from nonadenomatous histology was 0.78 (95% CI 0.72–0.84) in P1 and 0.86 (95% CI 0.77–0.92) in P2 (p = 0.164); assignments made with a high confidence level achieved statistical significance (13% improvement, 95% CI 3–22%; p = 0.022). The negative predictive value for adenomatous histology of diminutive rectosigmoid polyps was 81% (95% CI 64–93%) and 80% (95% CI 59–93%) in P1 and P2, respectively. Conclusions: Nonexpert endoscopists achieved moderate accuracy for real-time optical diagnosis of colorectal lesions with the NICE/WASP classifications. The overall performance of the endoscopists improved after sustained use of optical diagnosis, but did not achieve the standards for the implementation of the “do not resect” strategy.

© 2019 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel

Diagnóstico óptico em tempo real de pólipos colo-rectais na prática clínica diária com as classificações de NICE e WASP num centro não académico

Palavras Chave

Pólipos colo-rectais · Narrow-band imaging · Diagnóstico óptico · Curva de aprendizagem ·

Resumo

Introdução: O narrow-band imaging (NBI) permite a classificação “in-vivo” dos pólipos colo-rectais. Objectivos: Avaliámos o diagnóstico óptico na prática clínica diá ria em endoscopistas da comunidade, sem experiência prévia em NBI, o impacto do treino e se estes conseguiam atingir o limiar da estratégia de “não ressecar”. Métodos: Estudo observacional, realizado em dois períodos (P1 e P2). Os endoscopistas não apresentavam experiência prévia em NBI em P1 e aplicaram a técnica diariamente durante um ano antes da participação em P2. As lesões foram classificadas aplicando as classificações NBI International Colorectal Endoscopic (NICE) e Workgroup serrAted polypS and Polyposis (WASP), simultaneamente. Resultados: Foram analisados 290 pólipos. A acuidade global do diagnóstico óptico foi de 0.75 (IC 95%, 0.68–0.81) em P1, aumentando para 0.82 (IC 95%, 0.73–0.89) em P2 (p = 0.260). A acuidade das classificações de NICE/WASP na diferenciação de histologia adenomatosa de não-adenomatosa foi de 0.78 (IC 95%, 0.72–0.84) em P1, e 0.86 (IC 95%, 0.77–0.92) em P2 (p = 0.164); as predições realizadas com alto grau de confiança alcançaram significado estatístico (melhoria de 13%, IC 95%, 3–22%; p = 0.022). O valor preditivo negativo para histologia adenomatosa dos pólipos diminutos recto-sigmóides foi de 81% (IC 95%, 64–93%) e 80% (IC 95%, 59–93%), em P1 e P2, respetivamente. Conclusões: Endoscopistas sem experiência em NBI alcançaram acuidade moderada no diagnóstico óptico em tempo real de lesões colo-rectais, utilizando as classificações de NICE/WASP. O desempenho global me­lhorou após a utilização contínua do diagnóstico óptico, mas não alcançou o limiar definido para a implementação da estratégia de “não ressecar”.



Related Articles:

References

  1. Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb;366(8):687–96.
    External Resources
  2. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008 Oct;135(4):1100–5.
    External Resources
  3. Rex DK, Overhiser AJ, Chen SC, Cummings OW, Ulbright TM. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol. 2009 Jan;104(1):149–53.
    External Resources
  4. Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006 Mar;4(3):343–8.
    External Resources
  5. Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006 Nov;355(18):1863–72.
    External Resources
  6. Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 2010 Oct;8(10):865–9, 869.e1–3.
  7. Rex DK, Kahi C, O’Brien M, Levin TR, Pohl H, Rastogi A, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011 Mar;73(3):419–22.
    External Resources
  8. Song LM, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, et al.; ASGE Technology Committee. Narrow band imaging and multiband imaging. Gastrointest Endosc. 2008 Apr;67(4):581–9.
    External Resources
  9. Patel SG, Rastogi A, Austin G, Hall M, Siller BA, Berman K, et al. Gastroenterology trainees can easily learn histologic characterization of diminutive colorectal polyps with narrow band imaging. Clin Gastroenterol Hepatol. 2013 Aug;11(8):997–1003.e1.
  10. Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012 Sep;143(3):599–607.e1.
  11. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988 Sep;319(9):525–32.
    External Resources
  12. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011 Jan;42(1):1–10.
    External Resources
  13. Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010 Jun;138(6):2088–100.
    External Resources
  14. De Sousa E Melo F, Wang X, Jansen M, Fessler E, Trinh A, de Rooij LP, et al. Poor-prognosis colon cancer is defined by a molecularly distinct subtype and develops from serrated precursor lesions. Nat Med. 2013 May;19(5):614–8.
    External Resources
  15. Ijspeert JE, Bastiaansen BA, van Leerdam ME, Meijer GA, van Eeden S, Sanduleanu S, et al.; Dutch Workgroup serrAted polypS & Polyposis (WASP). Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut. 2016 Jun;65(6):963–70.
    External Resources
  16. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3–43.
    External Resources
  17. Ignjatovic A, East JE, Suzuki N, Vance M, Guenther T, Saunders BP. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol. 2009 Dec;10(12):1171–8.
    External Resources
  18. Bosman FT, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. Lyon: IARC Press; 2010.
  19. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. 2009 Apr;136(4):1174–81.
    External Resources
  20. Rastogi A, Keighley J, Singh V, Callahan P, Bansal A, Wani S, et al. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009 Oct;104(10):2422–30.
    External Resources
  21. Pohl H, Bensen SP, Toor A, Gordon SR, Levy LC, Anderson PB, et al. Quality of optical diagnosis of diminutive polyps and associated factors. Endoscopy. 2016 Sep;48(9):817–22.
    External Resources
  22. Ladabaum U, Fioritto A, Mitani A, Desai M, Kim JP, Rex DK, et al. Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology. 2013 Jan;144(1):81–91.
    External Resources
  23. Rees CJ, Rajasekhar PT, Wilson A, Close H, Rutter MD, Saunders BP, et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut. 2017 May;66(5):887–95.
    External Resources
  24. Vu HT, Sayuk GS, Hollander TG, Clebanoff J, Edmundowicz SA, Gyawali CP, et al. Resect and discard approach to colon polyps: real-world applicability among academic and community gastroenterologists. Dig Dis Sci. 2015 Feb;60(2):502–8.
    External Resources
  25. Kuiper T, Marsman WA, Jansen JM, van Soest EJ, Haan YC, Bakker GJ, et al. Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol. 2012 Sep;10(9):1016–20; quiz e79.
    External Resources
  26. Seref Köksal A, Yıldız H, Taşkıran I, Turhan N, Oztaş E, Torun S, et al. Low magnification narrow band imaging by inexperienced endoscopists has a high accuracy in differentiation of colon polyp histology. Clin Res Hepatol Gastroenterol. 2014 Dec;38(6):763–9.
    External Resources
  27. Patel SG, Schoenfeld P, Kim HM, Ward EK, Bansal A, Kim Y, et al. Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. Gastroenterology. 2016 Feb;150(2):406–18.
    External Resources
  28. Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, et al. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc. 2010 Jul;72(1):127–35.
    External Resources
  29. Ignjatovic A, Thomas-Gibson S, East JE, Haycock A, Bassett P, Bhandari P, et al. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc. 2011 Jan;73(1):128–33.
    External Resources
  30. Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc. 2010 Sep;72(3):572–6.
    External Resources
  31. Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008 Dec;68(6):1136–45.
    External Resources
  32. East JE, Suzuki N, Bassett P, Stavrinidis M, Thomas HJ, Guenther T, et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. 2008 Oct;40(10):811–7.
    External Resources
  33. Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y, Wanders LK, Fockens P, Dekker E, et al.; DISCOUNT Study Group. Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps. Gastroenterology. 2018 May;154(6):1682–93.e1.
  34. McGill SK, Soetikno R, Rastogi A, Rouse RV, Sato T, Bansal A, et al. Endoscopists can sustain high performance for the optical diagnosis of colorectal polyps following standardized and continued training. Endoscopy. 2015 Mar;47(3):200–6.
    External Resources
  35. Khan T, Cinnor B, Gupta N, Hosford L, Bansal A, Olyaee MS, et al. Didactic training vs. computer-based self-learning in the prediction of diminutive colon polyp histology by trainees: a randomized controlled study. Endoscopy. 2017 Dec;49(12):1243–50.
    External Resources
  36. Wallace MB. Not so NICE to be serrated. Gastrointest Endosc. 2013 Dec;78(6):910–1.
    External Resources
  37. Singh A, Konda VJ, Siddiqui UD. The not so NICE classification. Gastrointest Endosc. 2014 Jun;79(6):1030–1.
    External Resources
  38. Kumar S, Fioritto A, Mitani A, Desai M, Gunaratnam N, Ladabaum U. Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging? Gastrointest Endosc. 2013 Dec;78(6):902–9.
    External Resources
  39. Parikh ND, Chaptini L, Njei B, Laine L. Diagnosis of sessile serrated adenomas/polyps with image-enhanced endoscopy: a systematic review and meta-analysis. Endoscopy. 2016 Aug;48(8):731–9.
    External Resources
  40. Rastogi A, Pondugula K, Bansal A, Wani S, Keighley J, Sugar J, et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009 Mar;69(3 Pt 2):716–22.
    External Resources
  41. Klare P, Haller B, Wormbt S, Nötzel E, Hartmann D, Albert J, et al. Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial. Endoscopy. 2016 Oct;48(10):909–15.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: September 24, 2018
Accepted: November 02, 2018
Published online: January 10, 2019
Issue release date: September - October

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 5

ISSN: 2341-4545 (Print)
eISSN: 2387-1954 (Online)

For additional information: https://www.karger.com/PJG

References

  1. Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012 Feb;366(8):687–96.
    External Resources
  2. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology. 2008 Oct;135(4):1100–5.
    External Resources
  3. Rex DK, Overhiser AJ, Chen SC, Cummings OW, Ulbright TM. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol. 2009 Jan;104(1):149–53.
    External Resources
  4. Butterly LF, Chase MP, Pohl H, Fiarman GS. Prevalence of clinically important histology in small adenomas. Clin Gastroenterol Hepatol. 2006 Mar;4(3):343–8.
    External Resources
  5. Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006 Nov;355(18):1863–72.
    External Resources
  6. Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol. 2010 Oct;8(10):865–9, 869.e1–3.
  7. Rex DK, Kahi C, O’Brien M, Levin TR, Pohl H, Rastogi A, et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc. 2011 Mar;73(3):419–22.
    External Resources
  8. Song LM, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, et al.; ASGE Technology Committee. Narrow band imaging and multiband imaging. Gastrointest Endosc. 2008 Apr;67(4):581–9.
    External Resources
  9. Patel SG, Rastogi A, Austin G, Hall M, Siller BA, Berman K, et al. Gastroenterology trainees can easily learn histologic characterization of diminutive colorectal polyps with narrow band imaging. Clin Gastroenterol Hepatol. 2013 Aug;11(8):997–1003.e1.
  10. Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology. 2012 Sep;143(3):599–607.e1.
  11. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988 Sep;319(9):525–32.
    External Resources
  12. Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol. 2011 Jan;42(1):1–10.
    External Resources
  13. Leggett B, Whitehall V. Role of the serrated pathway in colorectal cancer pathogenesis. Gastroenterology. 2010 Jun;138(6):2088–100.
    External Resources
  14. De Sousa E Melo F, Wang X, Jansen M, Fessler E, Trinh A, de Rooij LP, et al. Poor-prognosis colon cancer is defined by a molecularly distinct subtype and develops from serrated precursor lesions. Nat Med. 2013 May;19(5):614–8.
    External Resources
  15. Ijspeert JE, Bastiaansen BA, van Leerdam ME, Meijer GA, van Eeden S, Sanduleanu S, et al.; Dutch Workgroup serrAted polypS & Polyposis (WASP). Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut. 2016 Jun;65(6):963–70.
    External Resources
  16. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003 Dec;58(6 Suppl):S3–43.
    External Resources
  17. Ignjatovic A, East JE, Suzuki N, Vance M, Guenther T, Saunders BP. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol. 2009 Dec;10(12):1171–8.
    External Resources
  18. Bosman FT, Hruban RH, Theise ND. WHO Classification of Tumours of the Digestive System. Lyon: IARC Press; 2010.
  19. Rex DK. Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology. 2009 Apr;136(4):1174–81.
    External Resources
  20. Rastogi A, Keighley J, Singh V, Callahan P, Bansal A, Wani S, et al. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009 Oct;104(10):2422–30.
    External Resources
  21. Pohl H, Bensen SP, Toor A, Gordon SR, Levy LC, Anderson PB, et al. Quality of optical diagnosis of diminutive polyps and associated factors. Endoscopy. 2016 Sep;48(9):817–22.
    External Resources
  22. Ladabaum U, Fioritto A, Mitani A, Desai M, Kim JP, Rex DK, et al. Real-time optical biopsy of colon polyps with narrow band imaging in community practice does not yet meet key thresholds for clinical decisions. Gastroenterology. 2013 Jan;144(1):81–91.
    External Resources
  23. Rees CJ, Rajasekhar PT, Wilson A, Close H, Rutter MD, Saunders BP, et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut. 2017 May;66(5):887–95.
    External Resources
  24. Vu HT, Sayuk GS, Hollander TG, Clebanoff J, Edmundowicz SA, Gyawali CP, et al. Resect and discard approach to colon polyps: real-world applicability among academic and community gastroenterologists. Dig Dis Sci. 2015 Feb;60(2):502–8.
    External Resources
  25. Kuiper T, Marsman WA, Jansen JM, van Soest EJ, Haan YC, Bakker GJ, et al. Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol. 2012 Sep;10(9):1016–20; quiz e79.
    External Resources
  26. Seref Köksal A, Yıldız H, Taşkıran I, Turhan N, Oztaş E, Torun S, et al. Low magnification narrow band imaging by inexperienced endoscopists has a high accuracy in differentiation of colon polyp histology. Clin Res Hepatol Gastroenterol. 2014 Dec;38(6):763–9.
    External Resources
  27. Patel SG, Schoenfeld P, Kim HM, Ward EK, Bansal A, Kim Y, et al. Real-Time Characterization of Diminutive Colorectal Polyp Histology Using Narrow-Band Imaging: Implications for the Resect and Discard Strategy. Gastroenterology. 2016 Feb;150(2):406–18.
    External Resources
  28. Higashi R, Uraoka T, Kato J, Kuwaki K, Ishikawa S, Saito Y, et al. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc. 2010 Jul;72(1):127–35.
    External Resources
  29. Ignjatovic A, Thomas-Gibson S, East JE, Haycock A, Bassett P, Bhandari P, et al. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc. 2011 Jan;73(1):128–33.
    External Resources
  30. Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc. 2010 Sep;72(3):572–6.
    External Resources
  31. Rogart JN, Jain D, Siddiqui UD, Oren T, Lim J, Jamidar P, et al. Narrow-band imaging without high magnification to differentiate polyps during real-time colonoscopy: improvement with experience. Gastrointest Endosc. 2008 Dec;68(6):1136–45.
    External Resources
  32. East JE, Suzuki N, Bassett P, Stavrinidis M, Thomas HJ, Guenther T, et al. Narrow band imaging with magnification for the characterization of small and diminutive colonic polyps: pit pattern and vascular pattern intensity. Endoscopy. 2008 Oct;40(10):811–7.
    External Resources
  33. Vleugels JLA, Dijkgraaf MGW, Hazewinkel Y, Wanders LK, Fockens P, Dekker E, et al.; DISCOUNT Study Group. Effects of training and feedback on accuracy of predicting rectosigmoid neoplastic lesions and selection of surveillance intervals by endoscopists performing optical diagnosis of diminutive polyps. Gastroenterology. 2018 May;154(6):1682–93.e1.
  34. McGill SK, Soetikno R, Rastogi A, Rouse RV, Sato T, Bansal A, et al. Endoscopists can sustain high performance for the optical diagnosis of colorectal polyps following standardized and continued training. Endoscopy. 2015 Mar;47(3):200–6.
    External Resources
  35. Khan T, Cinnor B, Gupta N, Hosford L, Bansal A, Olyaee MS, et al. Didactic training vs. computer-based self-learning in the prediction of diminutive colon polyp histology by trainees: a randomized controlled study. Endoscopy. 2017 Dec;49(12):1243–50.
    External Resources
  36. Wallace MB. Not so NICE to be serrated. Gastrointest Endosc. 2013 Dec;78(6):910–1.
    External Resources
  37. Singh A, Konda VJ, Siddiqui UD. The not so NICE classification. Gastrointest Endosc. 2014 Jun;79(6):1030–1.
    External Resources
  38. Kumar S, Fioritto A, Mitani A, Desai M, Gunaratnam N, Ladabaum U. Optical biopsy of sessile serrated adenomas: do these lesions resemble hyperplastic polyps under narrow-band imaging? Gastrointest Endosc. 2013 Dec;78(6):902–9.
    External Resources
  39. Parikh ND, Chaptini L, Njei B, Laine L. Diagnosis of sessile serrated adenomas/polyps with image-enhanced endoscopy: a systematic review and meta-analysis. Endoscopy. 2016 Aug;48(8):731–9.
    External Resources
  40. Rastogi A, Pondugula K, Bansal A, Wani S, Keighley J, Sugar J, et al. Recognition of surface mucosal and vascular patterns of colon polyps by using narrow-band imaging: interobserver and intraobserver agreement and prediction of polyp histology. Gastrointest Endosc. 2009 Mar;69(3 Pt 2):716–22.
    External Resources
  41. Klare P, Haller B, Wormbt S, Nötzel E, Hartmann D, Albert J, et al. Narrow-band imaging vs. high definition white light for optical diagnosis of small colorectal polyps: a randomized multicenter trial. Endoscopy. 2016 Oct;48(10):909–15.
    External Resources
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This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. 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.
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2019, Vol.26, No. 5

September - October

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