Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
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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 – 5 mm). 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 (1–5 mm), 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 1–5 mm 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 (1–5 mm), 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 1–5 mm. 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.
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Achieving PIVI and SODA competencies depends on the accuracy of high-confidence diagnoses, as these criteria are solely based on HC cases.
“Achieving PIVI and SODA competencies depends on the accuracy of high-confidence (HC) diagnoses, as these criteria are solely based on HC cases.2,8”
From Structured Integration of an Artificial Intelligence-Based System for the Optical Diagnosis of Colorectal Polyps (2026) · cites this paper as [8]
Figure 2 (page not specified in our copy) defines both SODA competence standards using sensitivity and specificity for high-confidence optical diagnoses, supporting that part of the claim. The Introduction mentions PIVI competence criteria but does not establish in the passages found that they are based solely on high-confidence cases, so the claim about both sets of criteria is not fully supported. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAttaining proficiency in optical diagnosis and meeting the SODA or PIVI standards can be particularly challenging for novices.
“Attaining proficiency in optical diagnosis and meeting the accurate standards established by Simple Optical Diagnosis Accuracy (SODA) or Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) can be particularly challenging for novices.2,7,8”
From Structured Integration of an Artificial Intelligence-Based System for the Optical Diagnosis of Colorectal Polyps (2026) · cites this paper as [8]
The Introduction (page unavailable) says proficiency requires training and meeting competence standards, and that PIVI criteria are difficult to implement in daily practice. It does not say novices particularly struggle to attain proficiency or meet either standard; the Conclusion and future prospects instead describes SODA standards as achievable. (LLM, conf=0.83)
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- Authors
- Houwen, B. B. S. L., Hassan, C., Coupé, V. M. H., Greuter, M. J. E., Hazewinkel, Y., Vleugels, J. L. A., Antonelli, G., Bustamante-Balén, M., Coron, E., Cortas, G. A., Dinis-Ribeiro, M., Dobru, D. E., East, J. E., Iacucci, M., Jover, R., Kuvaev, R., Neumann, H., Pellisé, M., Puig, I., Rutter, M. D., Saunders, B., Tate, D. J., Mori, Y., Longcroft-Wheaton, G., Bisschops, R., & Dekker, E.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Humanitas University (IT)
- Amsterdam University Medical Centers (NL)
- Radboud University Nijmegen (NL)
- Sapienza University of Rome (IT)
- Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain
- Institut des Maladies de l'Appareil Digestif, Nantes, France
- University of Balamand (LB)
- Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal
- Universitatea de Medicină, Farmacie, Științe și Tehnologie „George Emil Palade” din Târgu Mureș (RO)
- Mayo Clinic (US)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Hospital General Universitario de Alicante Doctor Balmis (ES)
- Pirogov Russian National Research Medical University (RU)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Vic - Universitat Central de Catalunya (ES)
- University Hospital of North Tees (GB)
- St Mark's Hospital (GB)
- Ghent University Hospital (BE)
- Oslo University Hospital (NO)
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, UK
- Universitair Ziekenhuis Leuven (BE)
- ORCID
- Houwen, Britt B. S. L.
- Hassan, Cesare
- Coupé, Veerle M. H.
- Greuter, Marjolein J. E.
- Antonelli, Giulio
- Bustamante-Balén, Marco
- Coron, Emmanuel
- Dobru, Daniela E.
- East, James E.
- Iacucci, Marietta
- Jover, Rodrigo
- Kuvaev, Roman
- Neumann, Helmut
- Pellisé, Maria
- Puig, Ignasi
- Rutter, Matthew D.
- Saunders, Brian
- Tate, David J.
- Mori, Yuichi
- Bisschops, Raf
- Dekker, Evelien
- Venue
- Endoscopy
- Publisher
- Georg Thieme Verlag KG
- Published
- 2021-12-06
- Volume
- 54
- Issue
- 01
- Pages
- 88-99
- ISSN
- 0013-726X (ISSN-L)
- 1438-8812
- OpenAlex
- W4200300623
- Cited by
- 99
- References
- 0
- Citations by year
- 2026: 15 · 2025: 28 · 2024: 28 · 2023: 17 · 2022: 10 · 2021: 1
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Lirias (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Fonds Wetenschappelijk Onderzoek
- Vlaamse regering
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Keywords
- diminutive colorectal polyps, optical diagnostics, competence standards, colorectal neoplasia, resect and discard strategy, endoscopist training, artificial intelligence in endoscopy, colonoscopy, rectosigmoid
- MeSH terms
- Artificial Intelligence, Colonic Polyps, Colonoscopy, Humans, Colorectal Neoplasms, Endoscopy, Gastrointestinal
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