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

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 (K = 0.69 for all participants, K = 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. (Gastrointest Endosc 2010; 72:572-6.)