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Efficacy of international web-based educational intervention

Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial.

Mineo Iwatate, Daizen Hirata, Carlos Paolo D Francisco, Jonard Tan Co, Jeong-Sik Byeon, Neeraj Joshi, Rupa Banerjee, Duc Trong Quach, Than Than Aye, Han-Mo Chiu, Louis H S Lau, Siew C Ng, Tiing Leong Ang, Supakij Khomvilai, Xiao-Bo Li, Shiaw-Hooi Ho, Wataru Sano, Santa Hattori, Mikio Fujita, Yoshitaka Murakami, Masaaki Shimatani , Yuzo Kodama, Yasushi Sano, CATCH project team

Published in Sep 2022, Digestive endoscopy.



Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs.


This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs.


In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively.


Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists.


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