Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps

Gastrointest Endosc. 2011 Jan;73(1):128-33. doi: 10.1016/j.gie.2010.09.021.


Background: Experts are accurate in differentiating small adenomas from hyperplastic polyps at colonoscopy by using narrow-band imaging (NBI).

Objective: To prospectively evaluate the effectiveness of an NBI training module on individuals with varying colonoscopy experience.

Design: Prospective educational evaluation study.

Setting: Academic endoscopy unit.

Participants: Twenty-one participants of varying colonoscopy experience (novices, trainees, and experienced gastroenterologists) and 5 experts in NBI.

Intervention: Participants completed a computer-based test module consisting of 30 NBI polyp images. No feedback was given. They then completed a computer-based training module on the use of NBI in the differentiation of adenomas and hyperplastic polyps. The test module was then completed a second time.

Main outcome measurements: Construct validity (the difference in baseline accuracy on the test module between different groups of participants) and content validity (difference in accuracy achieved on the test module before and after training) of the training module.

Results: There was a significant difference in the baseline accuracy (P < .001) between experts (0.95; 95% confidence interval [CI], 0.92-0.97), experienced colonoscopists (0.68; 95% CI, 0.68-0.74), trainees (0.75; 95% CI, 0.67-0.82), and novices (0.62; 95% CI, 0.46-0.77). Accuracy increased significantly (P < .001) for all 3 groups after training (novices 0.84; 95% CI, 0.78-0.88, trainees 0.90; 95% CI, 0.84-0.93, and experienced colonoscopists 0.84; 95% CI, 0.76-0.89). After training, the agreement was moderate at least (κ = 0.56 for novices, κ = 0.70 for trainees, and κ = 0.54 for experienced colonoscopists).

Limitations: This study did not assess the accuracy of optical diagnosis in routine clinical practice.

Conclusion: A short, computer-based training module can improve the diagnostic accuracy and interobserver agreement for the use of NBI to differentiate adenomas from hyperplastic polyps and could be used for the initial training in optical diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / pathology*
  • Clinical Competence
  • Colonic Neoplasms / pathology*
  • Colonic Polyps / pathology*
  • Colonoscopy / methods
  • Computer-Assisted Instruction / methods*
  • Diagnosis, Differential
  • Education, Medical, Graduate / methods*
  • Gastroenterology / education*
  • Humans
  • Image Enhancement
  • Light*
  • Observer Variation
  • Prospective Studies
  • Quality Assurance, Health Care
  • Reproducibility of Results