Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial

Mineo Iwatate; Daizen Hirata; Carlos Paolo D Francisco; Jonard Tan Co; Jeong-Sik Byeon; Neeraj Joshi; Rupa Banerjee; Duc Trong Quach; Than Than Aye; Han-Mo Chiu; Louis H S Lau; Siew C Ng; Tiing Leong Ang; Supakij Khomvilai; Xiao-Bo Li; Shiaw-Hooi Ho; Wataru Sano; Santa Hattori; Mikio Fujita; Yoshitaka Murakami; Masaaki Shimatani; Yuzo Kodama; Yasushi Sano; CATCH project team

doi:10.1111/den.14244

Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial

Dig Endosc. 2022 Sep;34(6):1166-1175. doi: 10.1111/den.14244. Epub 2022 Mar 14.

Authors

Mineo Iwatate¹, Daizen Hirata^{1

2}, Carlos Paolo D Francisco³, Jonard Tan Co³, Jeong-Sik Byeon⁴, Neeraj Joshi⁵, Rupa Banerjee⁶, Duc Trong Quach⁷, Than Than Aye⁸, Han-Mo Chiu⁹, Louis H S Lau¹⁰, Siew C Ng¹⁰, Tiing Leong Ang¹¹, Supakij Khomvilai¹², Xiao-Bo Li¹³, Shiaw-Hooi Ho¹⁴, Wataru Sano¹, Santa Hattori¹, Mikio Fujita¹, Yoshitaka Murakami¹⁵, Masaaki Shimatani¹⁶, Yuzo Kodama¹⁷, Yasushi Sano^{1

18}; CATCH project team

Affiliations

¹ Gastrointestinal Center and Institute of Minimally-invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan.
² Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan.
³ Institute of Digestive and Liver Diseases, St. Luke's Medical Center, Taguig City, Philippines.
⁴ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵ Gastro Enterology Unit, Nepal Cancer Hospital and Research Centre, Lalitpur, Nepal.
⁶ Medical Gastroenterology, Asian Institute of Gastroenterology, New Delhi, India.
⁷ University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam.
⁸ University of Medicine 2, Yangon, Myanmar.
⁹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹⁰ Department of Medicine and Therapeutics, Faculty of Medicine, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
¹¹ Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore.
¹² Surgical Endoscopy, Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
¹³ Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, Shanghai, China.
¹⁴ Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
¹⁵ Department of Medical Statistics, Toho University, Tokyo, Japan.
¹⁶ The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan.
¹⁷ Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
¹⁸ Kansai Medical University, Osaka, Japan.

Abstract

Objectives: Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs.

Methods: This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs.

Results: In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively.

Conclusion: Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists. (UMIN000042348).

Keywords: colonoscopy; detection; education; flat and depressed lesions; randomized trial.

Publication types

Randomized Controlled Trial

MeSH terms

Asia
Colonoscopy* / methods
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / pathology
Humans
Internet

Grants and funding

2020/21/Asian Endoscopy Research Forum (AERF)