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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 04, 2019
Accepted:
February 2,
2019
Received:
October 1,
2018
Footnotes
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: T. Kaltenbach: Consultant for Olympus America and Aries Pharmaceutical. H. Pohl: Research grant recipient from Boston Scientific, US Endoscopy, and Aries/Cosmos Pharmaceuticals. A. Rastogi: Consultant for Olympus, Boston Scientific, Cook, and Medtronic; research grant recipient from Olympus. H. Hammad: Consultant for Olympus, Cook, and Medtronic. R. Soetikno: Consultant for Olympus. A. Shergill: Research grant recipient from Pentax. R. N. Keswani: Consultant for Boston Scientific, Medtronic, and Motus-GI. S. Wani: Consultant for Boston Scientific and Medtronic. All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by ASGE Quality in Endoscopy Award COMPLETE Study, 2017.
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- Video-based assessments: a promising step in improving polypectomy competencyGastrointestinal EndoscopyVol. 89Issue 6
- PreviewAssessment 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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