title: Development and validation of a training module on the use of acetic acid for the detection of Barrett's neoplasia.
abstract: Background and study aimsAcetic acid chromoendoscopy (AAC) enhances the ability to correctly identify Barrett's neoplasia, and is increasingly used by both expert and nonexpert endoscopists. Despite its increasing use, there is no validated training strategy to achieve competence. The aims of our study were to develop a validated training tool in AAC-assisted lesion recognition, to assess endoscopists' baseline knowledge of AAC-assisted lesion recognition, and to evaluate the efficacy and impact of this training tool.MethodsA validated assessment of 40 images and 20 videos was developed. A total of 13 endoscopists with experience of Barrett's endoscopy but no formal training in AAC were recruited to the study. Participants underwent: baseline assessment 1, online training, assessment 2, interactive seminar, assessment 3.ResultsBaseline assessment demonstrated a sensitivity of 83 % and a negative predictive value (NPV) of 83 %. The online training intervention significantly improved sensitivity to 95 % and NPV to 94 % (P< 0.01). Further improvement was seen after a 1-day interactive seminar including live cases, with sensitivity increasing to 98 % and NPV to 97 %.ConclusionsThe data demonstrate the need for training in AAC-assisted lesion recognition as baseline performance, even by Barrett's experts, was poor. The online training and testing tool for AAC for Barrett's neoplasia was successfully developed and validated. The training intervention improved performance of endoscopists to meet ASGE PIVI standards. The training tool increases the endoscopist's degree of confidence in the use of AAC. The training tool also leads to shift in attitudes of endoscopists from Seattle protocol towards AAC-guided biopsy protocol for Barrett's surveillance.
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Fergus J Q
authors.initials: FJQ
authors.lastname: Chedgy
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Kesavan
authors.initials: K
authors.lastname: Kandiah
authors.affiliation: Department of Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom.
authors.forename: Hugh
authors.initials: H
authors.lastname: Barr
authors.affiliation: Department of Gastroenterology, Leicester General Hospital, Leicester, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: De Caestecker
authors.affiliation: Department of Surgery, Gloucestershire Royal Hospital, Gloucester, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Dwerryhouse
authors.affiliation: Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors.forename: Balint
authors.initials: B
authors.lastname: Eross
authors.affiliation: Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Gordon
authors.affiliation: Department of Gastroenterology, Royal Sussex County Hospital, Brighton, United Kingdom.
authors.forename: Susi
authors.initials: S
authors.lastname: Green
authors.affiliation: Department of Gastroenterology, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Li
authors.affiliation: School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Brown
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Gaius
authors.initials: G
authors.lastname: Longcroft-Wheaton
authors.affiliation: Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
mesh_terms: D019342:Acetic Acid / Q000008:administration & dosage*; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D002983:Clinical Competence; D004945:Esophagoscopy / Q000193:education* / Q000379:methods / Q000592:standards*; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage*; D016730:Program Development
chemical_list: D007202:Indicators and Reagents; D019342:Acetic Acid