Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program
Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program
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DOI：
10.1016/j.gie.2010.01.054
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发表时间：
2010-07-01
影响因子：
7.7
通讯作者：
Yamamoto, Kazuhide
中科院分区：
文献类型：
--
作者：
Higashi, Reiji;Uraoka, Toshio;Yamamoto, Kazuhide
背景：以前的报告评估使用窄带成像（NBI）和坑型分析诊断结肠息肉的技能只涉及经验丰富的内窥镜医生。目的：评价经验不足的内窥镜医师（LEE组）的诊断技能。在扩大的训练计划后，使用NBI和坑型分析在放大和不放大的情况下对小型结肠息肉的鉴别。设计：前瞻性研究。患者：本研究纳入32例44例（27例为腺瘤，17例为增生性息肉），直径为5 mm，通过常规结肠镜检查、非放大、放大NBI和彩色内镜检查，并内镜切除进行组织病理学分析。干预：在培训课程之前，220张内镜图像按随机顺序分配给没有内镜经验的住院医师（NEE组）和进行结肠镜检查超过5年但从未使用过NBI的LEE组。220张图像也分发给经验丰富的内窥镜医师（HEE组），他们常规使用NBI超过5年。训练结束后，这些图像再次分发给NEE组和LEE组。放大后的NBI和色内窥镜图像分别采用Sano和Kudo分类系统进行评估。主要结果测量：每组每一种内镜模式的诊断准确性和观察者间的一致性。结果：扩大训练后，LEE组对高倍率NBI的诊断准确性显著提高，kappa值也有所改善。在训练后的LEE组和HEE组的内镜技术中，使用高倍NBI的诊断准确性和kappa值最高（准确率分别为90%和93%；kappa值分别为0.79和0.85）。局限性：研究仅涉及息肉
Background: Previous reports assessing diagnostic skill using narrow-band imaging (NBI) and pit pattern analysis for colorectal polyps involved only highly experienced endoscopists.Objective: To evaluate diagnostic skills of less-experienced endoscopists (LEE group) for. differentiation of diminutive colorectal polyps by using NBI and pit pattern analysis with and without magnification after an expanded training program.Design: Prospective study.Patients: This study involved 32 patients with 44 colorectal polyps (27 adenomas and 17 hyperplastic polyps) of 5 mm that were identified and analyzed by using conventional colonoscopy as well as non-magnification and magnification NBI and chromoendoscopy followed by endoscopic removal for histopathological analysis.Intervention: Before a training course, 220 endoscopic images were distributed in randomized order to residents with no prior endoscopy experience (NEE group) and to the LEE group, who had performed colonoscopies for more than 5 years but had never used NBI. The 220 images were also distributed to highly experienced endoscopists (HEE group) who had routinely used NBI for more than 5 years. The images were distributed to the NEE and LEE groups again after a training class. Magnification NBI and chromoendoscopy images were assessed by using the Sano and Kudo classification systems, respectively.Main Outcome Measurements: Diagnostic accuracy and interobserver agreement for each endoscopic modality in each group.Results: Diagnostic accuracy was significantly higher, and kappa (kappa) values improved in the LEE group for NBI with high magnification after expanded training. Diagnostic accuracy and kappa values when using high-magnification NBI were highest among endoscopic techniques for the LEE group after such training and the HEE group (accuracy 90% vs 93%; kappa = 0.79 vs 0.85, respectively).Limitations: Study involved only polyps of