Am J Gastroenterol. 2023 Sep 15. doi: 10.14309/ajg.0000000000002494. Online ahead of print.
INTRODUCTION: Polyp size determination plays an important role in endoscopic decision making and follow-up determination. However, there is a lack of knowledge of endoscopist accuracy for polyp sizing and efficacy of available tools for size measurement. Our aim was to compare the accuracy of visual assessment, snare, forceps, and a virtual scale endoscope (VSE) in estimating polyp size among a diverse group of endoscopists.
METHODS: We conducted a prospective video-based study. 120 polyps measured and recorded along with all available measurement tools were randomized to visual assessment, snare, forceps, or VSE group. 11 endoscopists conducted video-based measurement using the randomized measurement tool. Primary outcome was relative accuracy in polyp size measurement compared to caliper measurement immediately post-resection.
RESULTS: 1320 measurements were performed. VSE had statistically significantly higher relative accuracy when compared to forceps (79.3 vs 71.3%; p<0.0001). Forceps had statistically significantly higher relative accuracy when compared to visual assessment (71.3 vs 63.6%; p=0.0036). There was no statistically significant difference when comparing visual assessment and snare-based measurements (63.6 vs 62.8%; p=0.797). Overall, 21.5% of polyps >5mm were misclassified as ≤5mm and 17.3% of polyps ≥10mm were misclassified as <10mm. VSE had the lowest percentage of polyps >5mm misclassified as ≤5mm (2.6%); polyps ≤5mm misclassified as >5mm (5.1%); and polyps <10mm misclassified as ≥10mm (1.7%).
CONCLUSION: Visual size estimation of polyps is inaccurate independently of training level, sex, and specialty. Size measurement accuracy can be improved using forceps and yields the highest relative accuracy when an adaptive scale technology is used.