Detection of Endoscopic Resection Scars and Delineation of Recurrence is Trainable (SCAR)

Detection of Endoscopic Resection Scars and Delineation of Recurrence Amongst Non-experts is Less Accurate Than Experts But Trainable in a Short Learning Intervention

Colorectal cancer is prevented by colonoscopy and polypectomy. Failure to recognize the endoscopic resection scar after Endoscopic Mucosal Resection (EMR) risks unrecognized recurrent or residual adenoma (RRA), which may propagate into post-colonoscopy colorectal cancer. Expert series suggest scar recognition and interrogation is well performed with a high negative predictive value of endoscopic imaging vs histopathology. In this study the authors will investigate the performance of endoscopic imaging in detecting RRA at an endoscopic resection scar amongst general endoscopist and the impact of a learning intervention on recognition of RRA.

After consent is given, the participant will open the online survey and fill this in.

First the participant will be asked to create a pseudonym (name+year of birth) and fill in their demographical information (Grade, years in current role, colonoscopy experience, experience of colonic tissue resection, country of employment

The first 15 pictures will be shown prior to a learning intervention. For each picture the same questions will be asked:

• Is this an endoscopic resection scar?
• Based on this image does the scar demonstrate evidence of residual or recurrent adenoma (RRA)?
• What is your level of confidence?
• If the scar shows RRA, how would you treat it? (skip if you feel no RRA).
• If the scar does not show RRA do you feel there is another diagnosis? After the first 15 pictures a video-based learning tool will be shown on detection of RRA.

After the learning tool 15 different pictures will be shown, the same questions will be asked. All responses will be collected by the investigators. Statistical analysis will be performed using visual studio code (Microsoft, Redmond, USA) Images will be selected from the 'Australian Colonic LSL Endoscopic Resection Study' (ACE) database, which is an international multicentre registry of images and videos for retrospective analysis of colonic lesions. Images, videos, procedural information, and histopathological data are stored on a secure online web portal after written informed consent of every participating patient.

Study Overview

• Status: Recruiting
• Conditions: Colorectal Cancer; Colorectal Polyp
• Intervention / Treatment: Other: Learning tool

Detailed Description

Colorectal cancer is prevented by polypectomy. Failure to recognize the scar after EMR risks unrecognized recurrent or residual adenoma (RRA), which may propagate into post-colonoscopy colorectal cancer. Expert series suggest scar recognition and interrogation is well performed with a high negative predictive value of endoscopic imaging vs histopathology.

In this study the authors will investigate the performance of endoscopic imaging in detecting RRA at an endoscopic resection scar amongst general endoscopist and the impact of a learning intervention on recognition of RRA.

• Study Type: Interventional
• Enrollment (Estimated): 141
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: David J trate, PhD; Phone Number: +32 09 332 21 11; Email: David.tate@uzgent.be
• Study Contact Backup: Name: Sander Smeets, MD; Phone Number: +32 09 332 21 11; Email: sander.smeets@uzgent.be

Study Locations

• Belgium
  • Ghent, Belgium, 9000
    • Recruiting
    • UZ Gent

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Endoscopists of any experience level

Exclusion Criteria:

• non consenting adults

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Pre learning tool; Assessment of endoscopic images prior to a learning tool about scars and recurrence
Experimental: post learning tool; Assessment of endoscopic images after a learning tool about scars and recurrence	Other: Learning tool; Video based learning tool about detection of endoscopic resection scars and recurrence.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Performance of detecting a recurrence at an endoscopic resection scar.	Performance of detecting a recurrence at an endoscopic resection scar.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Performance of a learning tool in improving detection of recurrence at an endoscopic resection scar	Performance of a learning tool in improving detection of recurrence at an endoscopic resection scar	2 year
Difference in performance of detecting a recurrence at an endoscopic resection scar between endoscopists with different experience level	Difference in performance of detecting a recurrence at an endoscopic resection scar between endoscopists with different experience level	2 year
Performance of a learning tool in improving detection of recurrence at an endoscopic resection scar compared between endoscopists with different experience level	Performance of a learning tool in improving detection of recurrence at an endoscopic resection scar compared between endoscopists with different experience level	2 year

Collaborators and Investigators

• Sponsor: University Hospital, Ghent
• Investigators: Principal Investigator: David J Tate, PhD, UZ Ghent

Study record dates

Study Major Dates

• Study Start (Actual): November 11, 2024
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: December 21, 2023
• First Submitted That Met QC Criteria: January 4, 2024
• First Posted (Actual): January 5, 2024

Study Record Updates

• Last Update Posted (Actual): November 25, 2025
• Last Update Submitted That Met QC Criteria: November 19, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: advanced imaging; endoscopy; Colorectal polypectomy; post-colonoscopy colorectal cancer
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Intestinal Diseases; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colonic Diseases; Colorectal Neoplasms
• Other Study ID Numbers: ONZ-2024-0133 - ID16649

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made available to other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No