... Samir C. Grover1, Heather Carnahan2, Simon Ling4,. Jennifer Amadio1, Catharine M. Walsh3. 1Division of Gastroenterology, St. Michael's Hospital, Toronto, ...
Abstracts
video-based ratings of clinical colonoscopies for total GiECAT, GRS, and CL scores. A secondary outcome was the inter-rater reliability for total GiECAT, GRS and CL scores assigned independently by the 2 blinded video-based raters. Inter-rater reliability was calculated using intra-class correlation (ICC) coefficient. The ease of the video-based assessment was evaluated by asking assessors to rate how easy it was for them to assess the endoscopist’s performance on an ordinal scale of 1 (extremely easy) to 5 (extremely difficult). Results: 41 endoscopists participated (21 novices, 10 intermediates and 10 experienced). Overall, there was good agreement between live ratings and video-based ratings for the total GiECAT, GRS, and CL scores, with an ICC (single measures) of 0.847 (95% Confidence Interval [CI]: 0.732 to 0.915), 0.868 (95% CI: 0.768 to 0.927) and 0.749 (95% CI: 0.577 to 0.857), respectively. There was also excellent inter-rater reliability between the two blinded video-based raters for the total GiECAT, GRS, and CL scores, with an ICC (single measures) of 0.911 (95% CI: 0.839 to 0.951), 0.918 (95% CI: 0.852 to 0.955), and 0.862 (95% CI: 0.757 to 0.924), respectively. Assessors’ mean rating of ease of conducting a video-based assessment was 2.16+/0.82, with a score of 2 reflecting fairly easy. Conclusions: Blinded video-based assessments of endoscopic procedures are feasible and the ratings obtained using the GiECAT are comparable to those carried out within the clinical setting. These findings are in agreement with previous studies in the surgical domain, which have found that video-based assessments of technical skills are feasible, valid and reliable.
50 Biopsy Patterns of Gastric Polyps in the United States: Results From the Clinical Outcome Research Initiative (CORI) Database Juan E. Corral*1, Liege I. Diaz1, Douglas Morgan2, Daniel A. Sussman3, Tara Keihanian1 1 Department of Medicine, University of Miami Miller School of Medicine Jackson Memorial Hospital, Miami, FL; 2Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, TN; 3Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL
1. Sachin Gupta, Paul Bassett, Ripple Man, Noriko Suzuki, Margaret E. Vance, Siwan Thomas-Gibson, Validation of a novel method for assessing competency in polypectomy, Gastrointestinal Endoscopy, Volume 75, Issue 3, March 2012, Pages 568-575.e1
49 A Prospective Comparison of Live and Video-Based Assessments of Colonoscopy Performance Michael A. Scaffidi*1, Samir C. Grover1, Heather Carnahan2, Simon Ling4, Jennifer Amadio1, Catharine M. Walsh3 1 Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada; 2School of Human Kinetics and Recreation, Memorial University, St. John’s, Canada; 3The Learning Institute and the Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; 4Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada Background: Assessment of technical, cognitive, and integrative skills is a necessary consideration when teaching colonoscopy. Previous studies in surgery have indicated that both live and video-based assessments are reliable and feasible. However, no studies have examined the reliability of video compared to live assessment of endoscopic procedures. Aims: To determine if live and blinded video-based ratings of clinical endoscopic performance are in agreement with each other. Methods: Novice (performed 1000) endoscopists from 5 hospitals participated. Two views of each colonoscopy procedure were captured: an intraluminal view and a recording of the endoscopist’s hand movements during the procedure. Video recordings of each procedure were independently assessed by two blinded expert endoscopists. Live ratings were conducted by one non-blinded expert. Assessors used the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT), a validated procedurespecific assessment tool comprised of a global rating scale (GRS) and checklist (CL). The primary outcome was the inter-rater reliability between live ratings and blinded
AB116 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Introduction: Gastric polyps are frequently encountered incidentally at endoscopy. According to the most recent ASGE guidelines, complete polypectomy is recommended for solitary fundic polyps greater than one centimeter, hyperplastic polyps greater than five millimeters and all adenomatous polyps. The primary objective of this study was to describe clinical patterns when encountering gastric polyps in the era prior to these guidelines. The second aim was to identify missed opportunities for clinical interventions with gastric polyps to guide future provider education and promotion of ASGE guidelines. Methods: A retrospective review was performed using the CORI database, 3rd edition. Inclusion criteria: (i) esophagoduodenoscopy (EGD) procedure that reported gastric polyps (2000-2012) (ii) Polyps measuring up to 50 mm. If EGD was remarkable for multiple polyps, the largest polyp in maximal dimension was selected. Procedures performed in CORI are reported as a free-text; reviewers grouped procedures in three main categories: forceps sampling, snare removal or “other approach” (i.e. biopsy or polypectomy not further specified and visualization only). Results: Of 783,037 EGD procedures reported in the CORI database, 25,670 (3.28%) endoscopic procedures met inclusion criteria. Mean age was 60.78 14.07 years and the majority (82.98%) were non-Hispanic Whites. Sampling with forceps was reported in 15,978 (62.28%) and removal with a snare in 4,625 (18.02%). On average, polyps in the forceps group were smaller compared to the polyps in the snare group (5.7 4.0mm vs. 9.2 6.4mm, p1cm in size. Most of these polyps were sessile and located in the gastric fundus or cardia as opposed to the gastric body. Forceps sampling was more frequently performed in the outpatient facilities compared to the inpatient setting. 440 patients with a gastric polyp had a previous EGD during the 12-year period. Discussion/Conclusion: Anatomic location of polyps within the stomach and gross morphology were the main predictors of the endoscopic approach to polypectomy (snare vs. forceps). In this study, almost half of the polyps greater than 1cm (41.28%) were approached with a forceps, of which 30% were pedunculated polyps. Applying principles from colonic polypectomy to gastric polypectomy, using a snare to remove large, pedunculated polyps may obviate the need for repeat endoscopy to complete polypectomy. Table 1. Variables associated to forceps utilization
Categories Age
Ethnicity
0-30 31-60 >60 Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander/Native Am.
Gastric polyps >1cm treated with forceps biopsy, n(%) 13 448 595 792 102 120 33
43.33% 50.39% 48.65% 51.40% 47.89% 39.60% 50.00%
Crude odds ratio (95% CI) 1 1.33 (0.64 1.23 (0.59 1 0.87 (0.65 0.62 (0.48 0.95 (0.58 -
2.77) 2.57) 1.16) 0.80) 1.55)
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