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

Published:March 04, 2019DOI:https://doi.org/10.1016/j.gie.2019.02.018

      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).

      Methods

      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.

      Results

      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).

      Conclusions

      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.

      Abbreviations:

      CRC (colorectal cancer), CSPAT (cold snare polypectomy assessment tool), DOPyS (Direct Observation of Polypectomy Skills)
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      Linked Article

      • Video-based assessments: a promising step in improving polypectomy competency
        Gastrointestinal EndoscopyVol. 89Issue 6
        • Preview
          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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