Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Gastrointest Endosc. 2010 Mar;71(3):461-7, 467.e1-2. doi: 10.1016/j.gie.2009.10.020.
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.
To determine whether asynchronous tele-endoscopy using highly compressed video can accurately document and diagnose lesions in the upper GI tract.
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.
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.
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.
异步远程内镜检查可以提高患者护理的可及性和质量。这是首次对 GI 内镜中高度压缩数字视频的诊断准确性进行的发表评估。
确定使用高度压缩视频的异步远程内镜检查是否可以准确记录和诊断上消化道病变。
当地内镜医生进行了 50 例择期上消化道内镜检查。同时捕获高质量的 DV 压缩视频（25 兆位/秒[Mbps]，720 x 480 像素）和高度压缩的 MPEG-1 视频（2.0 Mbps，352 x 240 像素）。五位内镜医生异步审查了 20 个压缩数字视频（100 例病例审查）进行内镜诊断。此外，还使用李克特量表对演示技术和图像质量进行了评分。评估当地和异步内镜医生对主要和次要内镜发现的一致性。通过比较两种数字视频，通过独立小组将差异归类为图像质量、内镜技术或观察者间变异性引起的。
尽管异步内镜医生在 85%的情况下对高度压缩视频的图像质量进行了诊断，但只有 18%的研究得出了相同的临床诊断。主要（kappa = 0.38，95%CI，0.19-0.57）和次要发现（kappa = -0.29，95%CI，-0.43 至 -0.15）都存在高度不一致。观察者间报告的差异占 90%，而图像质量差仅占 4.9%。
这些发现表明，低带宽、低分辨率、高度压缩视频的诊断准确性可以很好地耐受，并且与当前标准相当。观察者间报告的差异是导致相关性差的主要原因。需要改进综合文件记录，以实现内镜医生之间的有效沟通。
