Supplementary Material for: Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size

Introduction: The virtual scale endoscope (VSE) is a newly introduced endoscope that helps endoscopists in measuring colorectal polyp size (CPS) during colonoscopy by displaying a virtual scale. This study aimed to determine the usefulness of the VSE for CPS measurement and the educational benefit of using VSE images to improve CPS estimation accuracy. Methods: This study included 42 colorectal polyps in 26 patients treated at Hiroshima University Hospital. In Study 1, CPS measured using a VSE before endoscopic mucosal resection was compared with CPS measured on resected specimens, and the agreement between the two measurement methods was evaluated via Bland–Altman analysis. In Study 2, 14 endoscopists (5 beginners, 5 intermediates, and 4 experts) took a pre-test to determine the size of 42 polyps. After the pre-test, a lecture on CPS measurement using VSE images was given. One month later, the endoscopists took a post-test to compare CPS accuracy before and after the lecture. Results: In Study 1, Bland–Altman analysis revealed no fixed or proportional errors. The mean bias ± 95% limits of agreement (±1.96 standard deviations) of the measurement error was -0.05 ± 0.21 mm, indicating that the agreement between two measurement methods was sufficient. In Study 2, the accuracy of CPS measurement was significantly higher among beginners (59.5% vs. 26.7%, p < 0.01) and intermediates (65.2% vs. 44.3%, p < 0.05) in the post-test than in the pre-test. Conclusion: The VSE accurately measures CPS before resection, and its images are useful teaching tools for beginner and intermediate endoscopists.