Effect of a polyp detection poster on detection of sessile serrated lesions: a prospective controlled study.

Background and study aims Colonoscopy is effective in reducing the incidence of colorectal cancer, but interval cancers remain a concern and their occurrence mainly is thought to be due to poor detection of sessile serrated lesions (SSLs) and advanced neoplasia (AN). Currently there are no low-cost, easy-to-implement tools to improve detection of difficult-to-detect polyps. Our aims were to compare the detection rate for SSLs and AN between two groups of endoscopists at a large community practice, one of which received an intervention of a polyp detection poster displayed over the monitor in their endoscopy suite for 6 months. We compared preintervention and post-intervention detection rates in the intervention and control groups. Methods This was a convenience case control quality improvement project. For 6 months, a 2' × 3' poster of pictures of SSLs and advanced neoplasia was displayed over the monitor for 44 endoscopist in a large community gastroenterology practice in the Minneapolis/St.Paul area, while another 44 physicians performed colonoscopy in the usual fashion without the poster. The endpoints were improvement in detection rates for SSLs and AN preintervention and post-intervention between the control and intervention groups. Results During the study, 88 endoscopists performed 54,861 colonoscopies. At least one adenoma was detected in 41.3 % of patients, one or more SSLs in 11.4 %, and AN in 10.6 %. During the intervention period, the SSL detection rates were 10.9 % and 12.3 % for the control and intervention groups and for AN, the detection rates were 10.4 % and 10.75 % for the two groups, respectively. Exposure to the polyp detection poster significantly changed SSL detection for the intervention group relative to the control group (likelihood ratio test P  < 0.001). No significant effect of the intervention was observed for detection of AN, right-sided AN or left-sided AN, or adenoma detection rate. Conclusions Placement of a polyp detection poster above the endoscopy video monitor increased detection of SSL but not AN.

Remote Focusing in a Temporal Focusing Microscope.

In a temporal focusing microscope, dispersion can remotely shift the temporal focal plane axially, but only a single depth can be in focus at a time on a fixed camera. In this paper, we demonstrate remote focusing in a temporal focusing microscope. Dispersion tuning with an electrically tunable lens (ETL) in a 4 f pulse shaper scans the excitation plane axially, and another ETL in the detection path keeps the shifted excitation plane in focus on the camera. Image stacks formed using two ETLs versus a traditional stage scan are equivalent.