E-learning accelerates improvement of endoscopists' proximal serrated polyp detection rate: a randomized controlled trial

Background Recent studies demonstrated that a higher proximal serrated polyp detection rate among endoscopists is associated with a lower risk of post-colonoscopy colorectal cancer (PCCRC) incidence and death for their patients. Our objective was to evaluate the effect of an e-learning on proximal serrated polyp detection rate (PSPDR). Methods We performed a multicentre randomised controlled trial within the Dutch fecal immunochemical test based colorectal cancer screening program. Endoscopists were randomized using block-randomization per centre to receive an e-learning of 60 minutes on serrated polyp detection or not. PSPDR was calculated based on all colonoscopies performed during 27 months pre-intervention and 17 months post-intervention. Primary endpoint was difference in PSPDR between intervention and control arm (intention to treat) using mixed effect logistic regression modelling with time (pre-intervention/post-intervention) and interaction between time and arm (intervention/control) as fixed effects and endoscopist as random effect. Results Fifty-seven endoscopists were included in the intervention arm and fifty-nine endoscopists were included as controls. They performed in total 27,494 and 33,888 colonoscopies, respectively. Median PSPDR pre-intervention was 13.6% (95% CI,13.0-14.1) for the intervention arm and 13.8% (13.3-14.3) for controls. Post-intervention, the PSPDR was significantly higher over time in the intervention arm than controls (17.1% vs 15.4%, p=0.01). Conclusion In an era of increased awareness and increasing PSPDRs, endoscopists who performed an one-time e-learning significantly accelerated the increase of PSPDR compared to endoscopists who did not receive the e-learning. Widespread implementation might reduce PCCRCs incidence.