Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1-5mm). Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80% agreement was reached after a maximum of three voting rounds. Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1-5mm), it is clinically acceptable if, during real-time colonoscopy, at least 90% sensitivity and 80% specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5mm in the rectosigmoid. Histopathology is used as the gold standard. Level of agreement 95%. Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1-5mm), it is clinically acceptable if, during real-time colonoscopy, at least 80% sensitivity and 80% specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5mm. Histopathology is used as the gold standard. Level of agreement 100%. Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.