Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes

Gastrointest Endosc. 2010 Sep;72(3):572-6. doi: 10.1016/j.gie.2010.03.1124. Epub 2010 Jun 19.


Background: Colonoscopy with narrow-band imaging can allow real-time determination of polyp histology.

Objective: To determine whether physicians with varying levels of experience can learn and apply endoscopic criteria to distinguish between adenomas and hyperplastic polyps.

Design: Prospective observational study.

Setting: University teaching hospital.

Participants: This study involved 37 physicians (medical residents, N = 12; gastroenterology fellows, N = 12; and gastroenterology faculty, N = 13).

Intervention: Small-group, 20-minute, didactic teaching sessions in which the endoscopic criteria for determining polyp histology by using narrow-band imaging were described and demonstrated.

Main outcome measurements: Learning outcomes were evaluated by using written pretests and posttests in which participants scored pathologically verified, high-definition polyp photographs as adenomas or hyperplastic polyps.

Results: The mean overall scores increased significantly from 47.6% correct on the pretest to 90.8% correct on the posttest (P = .0001). The overall mean percentage of responses answered don't know was significantly lower on the posttest (0.6%) compared with the pretest (20.5%, P < .0001). After training, the level of agreement was substantial (kappa = 0.69 for all participants, kappa = 0.79 for fellows).

Limitations: Our study did not assess for sustained improvement with time or in vivo accuracy of histological prediction during live colonoscopy. Further validation in a sample of community physicians is required.

Conclusion: A short, didactic teaching session can achieve high accuracy and good interobserver agreement in the use of narrow-band imaging for determining the histology of colorectal polyps.

MeSH terms

  • Adenoma / diagnosis*
  • Adenoma / pathology
  • Colonic Polyps / diagnosis*
  • Colonic Polyps / pathology
  • Colonoscopy / education*
  • Colonoscopy / methods*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / pathology
  • Curriculum
  • Diagnosis, Differential
  • Faculty, Medical
  • Fellowships and Scholarships
  • Gastroenterology / education
  • Humans
  • Hyperplasia
  • Image Enhancement / methods*
  • Inservice Training*
  • Internship and Residency
  • Intestinal Mucosa / pathology
  • Observer Variation
  • Prospective Studies