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使用经过验证的诊断标准的简化表格可有效改善结直肠息肉的特征描述:CONECCT教学计划。

A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program.

作者信息

Fabritius Martin, Gonzalez Jean-Michel, Becq Aymeric, Dray Xavier, Coron Emmanuel, Brenet-Defour Lucie, Branche Julien, Gerard Romain, Lepage Côme, Poincloux Laurent, Lienhart Isabelle, Bonniaud Paul, Bounnah Mohamed Tayeb, Rivory Jérôme, Lépilliez Vincent, Subtil Fabien, Saurin Jean-Christophe, Ponchon Thierry, Jacques Jérémie, Pioche Mathieu

机构信息

Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.

Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France.

出版信息

Endosc Int Open. 2019 Oct;7(10):E1197-E1206. doi: 10.1055/a-0962-9737. Epub 2019 Oct 1.

Abstract

Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.  A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 - 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones.  A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively (  < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M (  < 0.001).  The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp.

摘要

结直肠息肉的准确实时内镜特征描述是选择最合适治疗方法的关键。掌握当前可用的分类具有挑战性。我们使用这些分类的验证标准创建了一个名为CONECCT的单一表格,并评估了基于该工具的教学计划的影响。 开展了一项涉及胃肠病学住院医师和主治医师的前瞻性多中心研究。在第一阶段,每位学员完成一项预测试,包括对20个结直肠息肉静止图像进行组织学预测和治疗选择。随后进行为期30分钟的关于CONECCT表格的课程,之后使用重新排列的相同静止图像进行后测试。在3至6个月后的第二阶段,进行最后一次测试(T3 M),包括这些相同的静止图像和20个新的静止图像。 2017年4月至2018年4月期间共有419名参与者参加了该教学计划。正确预测/治疗病变的平均比例从预测试到后测试再到T3 M有显著提高,分别从51.0%提高到74.0%和66.6%(<0.001)。在预测试和后测试之间,343名(86.6%)学员有进步,在T3 M时为153名(75.4%)。住院医师和主治医师对每种息肉亚型都有显著改善。在两个阶段之间,学员在息肉CONECCT IIA的组织学预测和治疗选择方面持续进步。过度治疗在测试后从30.1%显著降至15.5%,在T3 M时降至18.5%(<0.001)。 CONECCT教学计划对于提高胃肠病学家对每种结直肠息肉亚型的组织学预测和治疗选择是有效的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab10/6773571/fe4dc67cba5a/10-1055-a-0962-9737-i1487ei1.jpg

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