Effectiveness of asynchronous tele-endoscopy

Background: Asynchronous tele-endoscopy can improve access and quality of patient care. This is the first published evaluation of the diagnostic accuracy of highly compressed digital video in GI endoscopy.

Objective: To determine whether asynchronous tele-endoscopy using highly compressed video can accurately document and diagnose lesions in the upper GI tract.

Design: Local endoscopists performed 50 elective upper GI endoscopies. A high-quality DV compressed video (25 megabits per second [Mbps], 720 x 480 pixels) and highly compressed MPEG-1 video (2.0 Mbps, 352 x 240 pixels) were simultaneously captured. Five endoscopists asynchronously reviewed 20 compressed digital videos (100 case reviews) for endoscopic diagnoses. In addition, demonstration technique and image quality were rated on a Likert scale. Concordance between local and asynchronous endoscopists for major and minor endoscopic findings was evaluated. An independent panel classified discrepancies as caused by image quality, endoscopic technique, or interobserver variability through comparison of the 2 forms of digital video.

Results: Although asynchronous endoscopists rated the image quality of highly compressed video as diagnostic in 85% of cases, only 18% of studies yielded the same clinical diagnoses. There was high discordance for both major (kappa = 0.38, 95% CI, 0.19-0.57) and minor findings (kappa = -0.29, 95% CI, -0.43 to -0.15). Interobserver reporting was responsible for 90% of variability in contrast to only 4.9% for poor image quality.

Conclusions: The findings suggest that the diagnostic accuracy of low-bandwidth, low-resolution, highly compressed video is well tolerated and comparable to the current standard. Interobserver reporting variability accounted for most of the poor correlation. Improved synoptic documentation is required for effective communication among endoscopists.