Development and validation of a video-based cold snare polypectomy assessment tool (with videos)

Published:March 04, 2019DOI:

      Background and Aims

      Polyps <1 cm are the most commonly found polyps during colonoscopy. Cold snare removal is preferred given the significantly higher rate of incomplete resection associated with piecemeal biopsy forceps resection. There are currently no standardized tools to assess competence in cold snare polypectomy. This study aimed to develop and validate a cold snare polypectomy assessment tool (CSPAT).


      Experts in cold snare polypectomy used a Delphi method to develop the CSPAT. Metrics with a greater than 85% agreement as being “important” or “very important” were included in the CSPAT. The tool included evaluation of polyp inspection, positioning, appropriate ensnarement of tissue to ensure a rim of normal tissue, tissue retrieval, and postpolypectomy site inspection. Experts in cold snare polypectomy used the CSPAT to evaluate preselected videos that were previously evaluated using the Direct Observation of Polypectomy Skills (DOPyS) tool. Interobserver agreement was evaluated. CSPAT scores were compared with DOPyS scores to assess content validity.


      Sixteen experts developed the 12-item CSPAT, and 13 experts reviewed 55 videos. There was a moderate degree of agreement in 10 metrics (κ = .52-.59) and a substantial degree of agreement (κ = .61-.63) in the other 2. There was a strong correlation between the mean of individual metrics 1 to 12 compared with the global competence assessment (ρ = .88, P < .001). There was a moderate correlation between the average overall DOPyS score and the overall CSPAT competence score (ρ = .56, P < .001).


      We have developed and validated a customized CSPAT that can be easily applied to video-based assessments to assess competence in training and among practicing endoscopists.


      CRC (colorectal cancer), CSPAT (cold snare polypectomy assessment tool), DOPyS (Direct Observation of Polypectomy Skills)
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        • Siegel R.L.
        • Miller K.D.
        • Fedewa S.A.
        • et al.
        Colorectal cancer statistics, 2017.
        CA Cancer J Clin. 2017; 67: 177-193
        • Siegel R.L.
        • Fedewa S.A.
        • Anderson W.F.
        • et al.
        Colorectal cancer incidence patterns in the United States, 1974-2013.
        J Natl Cancer Inst. 2017; : 109
        • Edwards B.K.
        • Ward E.
        • Kohler B.A.
        • et al.
        Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates.
        Cancer. 2010; 116: 544-573
        • Centers for Disease Control and Prevention
        Vital signs: colorectal cancer screening, incidence, and mortality—United States, 2002-2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 884-889
        • Nishihara R.
        • Wu K.
        • Lochhead P.
        • et al.
        Long-term colorectal-cancer incidence and mortality after lower endoscopy.
        N Engl J Med. 2013; 369: 1095-1105
        • Lieberman D.
        • Moravec M.
        • Holub J.
        • et al.
        Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.
        Gastroenterology. 2008; 135: 1100-1105
        • Pohl H.
        • Srivastava A.
        • Bensen S.P.
        • et al.
        Incomplete polyp resection during colonoscopy—results of the Complete Adenoma Resection (CARE) Study.
        Gastroenterology. 2013; 144: 74-80
        • Raad D.
        • Tripathi P.
        • Cooper G.
        • et al.
        Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis.
        Gastrointest Endosc. 2016; 83: 508-515
        • Pabby A.
        • Schoen R.E.
        • Weissfeld J.L.
        • et al.
        Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial.
        Gastrointest Endosc. 2005; 61: 385-391
        • Robertson D.
        • Lieberman D.
        • Winawer S.J.
        • et al.
        Interval cancer after total colonoscopy: results from a pooled analysis of eight studies.
        Gastroenterology. 2008; 134: 111-112
        • Dekker E.
        • Rex D.K.
        Advances in CRC prevention: screening and surveillance.
        Gastroenterology. 2018; 154: 1970-1984
        • Duloy A.M.
        • Kaltenbach T.R.
        • Keswani R.N.
        Assessing colon polypectomy competency and its association with established quality metrics.
        Gastrointest Endosc. 2018; 87: 635-644
        • Patel S.G.
        • Keswani R.
        • Elta G.
        • et al.
        Status of competency-based medical education in endoscopy training: a nationwide survey of US ACGME-accredited gastroenterology training programs.
        Am J Gastroenterol. 2015; 110: 956-962
        • Patel S.
        • Rastogi A.
        • Austin G.
        • et al.
        Gastroenterology trainees can easily learn histologic characterization of diminutive colorectal polyps with narrow band imaging (NBI).
        Am J Gastroenterol. 2012; 107: S807
        • Higashi R.
        • Uraoka T.
        • Kato J.
        • 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; 72: 127-135
        • Committee A.T.
        • Sedlack R.E.
        • Coyle W.J.
        • et al.
        ASGE's assessment of competency in endoscopy evaluation tools for colonoscopy and EGD.
        Gastrointest Endosc. 2014; 79: 1-7
        • Barton J.R.
        • Corbett S.
        • van der Vleuten C.P.
        • et al.
        The validity and reliability of a Direct Observation of Procedural Skills assessment tool: assessing colonoscopic skills of senior endoscopists.
        Gastrointest Endosc. 2012; 75: 591-597
        • Vassiliou M.C.
        • Kaneva P.A.
        • Poulose B.K.
        • et al.
        Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy.
        Surg Endosc. 2010; 24: 1834-1841
        • Scaffidi M.A.
        • Grover S.C.
        • Carnahan H.
        • et al.
        A prospective comparison of live and video-based assessments of colonoscopy performance.
        Gastrointest Endosc. 2018; 87: 766-775
        • Scaffidi M.A.
        • Grover S.C.
        • Carnahan H.
        • et al.
        Impact of experience on self-assessment accuracy of clinical colonoscopy competence.
        Gastrointest Endosc. 2018; 87: 827-836
        • Gupta S.
        • Anderson J.
        • Bhandari P.
        • et al.
        Development and validation of a novel method for assessing competency in polypectomy: direct observation of polypectomy skills.
        Gastrointest Endosc. 2011; 73: 1232-1239
        • Gupta S.
        • Bassett P.
        • Man R.
        • et al.
        Validation of a novel method for assessing competency in polypectomy.
        Gastrointest Endosc. 2012; 75: 568-575
      1. Physicians RCo. New DOPS and DOPyS forms and certification criteria. Volume 2018, 2017. Available at: Accessed January 30, 2018.

        • Downing S.M.
        Validity: on meaningful interpretation of assessment data.
        Med Educ. 2003; 37: 830-837
        • Dalkey N.H.
        An experimental application of the Delphi method to the use of experts.
        Manage Sci. 1963; 9: 458-467
        • Bennett C.
        • Vakil N.
        • Bergman J.
        • et al.
        Consensus statements for management of Barrett's dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process.
        Gastroenterology. 2012; 143: 336-346
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Aziz Aadam A.
        • Wani S.
        • Kahi C.
        • et al.
        Physician assessment and management of complex colon polyps: a multicenter video-based survey study.
        Am J Gastroenterol. 2014; 109: 1312-1324
        • Robertson D.J.
        • Lieberman D.A.
        • Winawer S.J.
        • et al.
        Colorectal cancers soon after colonoscopy: a pooled multicohort analysis.
        Gut. 2014; 63: 949-956
      2. American Association for the Study of Liver Diseases, American College of Gastroenterologists, American Gastroenterological Association et al. The gastroenterology core curriculum, third edition. Gastroenterology 2007;132:2012-8.

      Linked Article

      • Video-based assessments: a promising step in improving polypectomy competency
        Gastrointestinal EndoscopyVol. 89Issue 6
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          Assessment is a critical component of endoscopic training, credentialing, and quality assurance. Evidence suggests significant variation in polypectomy competency among practicing endoscopists.1 The consequences of subpar polypectomy and incomplete resection are significant and include postcolonoscopy colorectal cancer.2 As such, polypectomy quality, although not currently highlighted in major society guidelines, is likely to become an important endoscopy quality metric in years to come. To properly measure quality, identify practice gaps, and highlight areas for improvement, robust assessment processes are necessary.
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