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Endoscopy 2022; 54(01): 88-99
DOI: 10.1055/a-1689-5130
Position Statement

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Britt B. S. L. Houwen 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
,
Cesare Hassan
 2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
 3   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
,
Veerle M. H. Coupé
 4   Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
,
Marjolein J. E. Greuter
 4   Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
,
Yark Hazewinkel
 5   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
,
Jasper L. A. Vleugels
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
,
Giulio Antonelli
 6   Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Rome, Italy
 7   Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
,
Marco Bustamante-Balén 
 8   Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
 9   Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
,
Emmanuel Coron
10   Institut des Maladies de l'Appareil Digestif, Nantes, France
,
George A. Cortas
11   Division of Gastroenterology, University of Balamand, Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
,
Mario Dinis-Ribeiro
12   Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
13   RISE@CI-IPOP (Health Research Network), Porto, Portugal
,
Daniela E. Dobru
14   Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
,
James E. East
15   Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK
16   Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London
,
Marietta Iacucci
17   Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
,
Rodrigo Jover
18   Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
,
Roman Kuvaev
19   Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
20   Department of Gastroenterology, Faculty of Additional Professional Education, N.A. Pirogov Russian National Research Medical University, Moscow, Russian Federation
,
Helmut Neumann 
21   Department of Medicine I, University Medical Center Mainz, Mainz, Germany
22   GastroZentrum, Lippe, Germany
,
Maria Pellisé 
23   Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
24   Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
,
Ignasi Puig 
25   Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
26   Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
,
Matthew D. Rutter 
27   Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
28   University Hospital of North Tees , Stockton-on-Tees, UK
,
Brian Saunders
29   Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
,
David J. Tate
30   Department of Gastroenterology and Hepatology, University of Ghent, Ghent, Belgium
31   University Hospital Ghent, Ghent, Belgium
,
Yuichi Mori 
32   Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
33   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
34   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Gaius Longcroft-Wheaton
35   Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, UK
,
Raf Bisschops 
36   Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
,
Evelien Dekker 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Abstract

Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 – 5 mm).

Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds.

Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm in the rectosigmoid. Histopathology is used as the gold standard.

Level of agreement 95 %.

Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm. Histopathology is used as the gold standard.

Level of agreement 100 %.

Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.

Tables 1 s–3 s



Publication History

Article published online:
06 December 2021

© 2021. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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