Thomas-Gibson, S.; Atkin, W.; Rutter, M.D.; Suzuki, N.; Vance, M.E.; Quraishy, M.S.; Swain, D.; Nicholls, A.; Saunders, B.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA34
Academic Journal
Background: Adenoma detection rates (ADR) at screening flexible sigmoidoscopy (FS) are known to be variable. No existing objective method for scoring endoscopy performance exists. Aims: To develop a video assessment tool that evaluates performance in FS for potential screening purposes, the main objective being confidence that no lesions are missed during an examination (exam). Methods: Eight experiments using video footage from a selection of 40 000 cases from the UK Flexible Sigmoidoscopy Screening Trial were performed. 5 experienced endoscopists independently scored, on average 5 exams from different endoscopists with varying ADRs. All experiments tested inter-observer variability (IOV), experiments 7 and 8 tested correlation of scores with ADR (validity) by looking at several cases from an individual endoscopist back-to-back. Cases were selected and extubations edited together by independent researchers. Variables assessed were: Bowel mucosa NOT visualised; Confidence NO lesion missed; Time spent viewing mucosa; re-exam of poorly viewed areas; Suctioning of fluid; Luminal distension; lower rectal exam; and overall quality of exam. Experiments 1-3 used Visual Analogue Scales (VAS), replaced in experiments 4-8 (due to high IOV) by grades A-E (A = excellent, B = good, C = needs improving, D = not good enough, E = unacceptable). Results: The A-E system produced less variability and more validity in predicting overall quality of exam. In experiments 7 and 8 the endoscopist with highest ADR was ranked as most technically proficient. In experiment 8 there was 100% agreement in 'Overall' score given for 2 of 3 endoscopists when 5 cases from each were viewed back-to-back. For the third, all scorers agreed that the endoscopist needed to improve their technique (Grades C or D). Conclusions: An objective performance score for screening FS based on video footage is possible. There is less inter-observer variability when 5 cases from an individual endoscopist are viewed...


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