Impact of an e-learning on the Proximal Serrated Polyp Detection Rate

Historically, colorectal cancer (CRC) was thought to exclusively derive from conventional adenomas. However, we now think that in addition to conventional adenomas, serrated polyps also significantly contribute to the occurrence of CRC. Indeed, an estimated 15-30% of all CRC seems to derive through the so-called serrated neoplasia pathway.1-3 Serrated polyps can be subdivided into three distinct subgroups, namely hyperplastic polyps (HP), sessile serrated lesion (SSL) and traditional serrated adenoma (TSA). HPs are considered benign, but the latter two are thought to harbor significant malignant potential.2 Our current knowledge of the malignant potential of serrated polyps has caused a paradigm shift in clinical practice. Because suboptimal detection and resection of serrated polyps might increase the risk of post-colonoscopy CRC, there is consensus that all proximal serrated polyps and distal serrated polyps >5mm in size should be resected.4 However, because of their flat and subtle appearance, serrated polyps are thought to be often missed during colonoscopy, and there is considerable variability in the detection of serrated polyps between endoscopists.5 Like the adenoma detection rate (ADR), the detection rate of serrated polyps might therefore also be related with the occurrence of interval carcinoma, although this relation has never been shown. 6, 7
Educational interventions aiming to increase adenoma detection are effective8, but methods to improve serrated polyp detection have not yet been studied. In a recent study, Wallace and colleagues showed that a short training aiming to improve ADR improves the ADR of individual endoscopists8, 9, but leaves the serrated polyp detection rate unchanged (not yet published). Considering the potential benefit that increased serrated polyp detection might have on the effectivity of colonoscopy, educational interventions specifically designed to increase serrated polyp detection should be developed and studied. The current study aims to assess the effect of a brief one-time e-learning that focuses on improving the detection of clinically relevant serrated polyps.

Endoscopists that received an online training module (December 2017) will increase their proximal serrated polyp detectionrate

Baseline measurement: January 1st 2017 until December 31st 2017
Post-training measurement: January 1st 2018 until June 1st 2019

An online training module / e-learning