Teaching Six “blink” features reduces general endoscopist cancer miss rate in image-based assessment of large colorectal polyps

Sep 23, 2026

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Accurate cancer detection in large non-pedunculated colorectal polyps remains difficult for general endoscopists. A prospective interventional study tested whether training six gross morphological “blink” features could improve image-based cancer identification. General endoscopists evaluated 20 LNPCP images before and after a 2-minute educational video. The cancer miss rate fell four-fold, while false alarms rose less than two-fold. Predictors included spontaneous bleeding, extra redness, and depression.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background and study aims

Methods

Results

Conclusions

Introduction

Accepted Manuscript online: 2026-05-10 Article published online: 2026-05-29 Original article Teaching Six “blink” features reduces general endoscopist cancer miss rate in image-based assessment of large colorectal polyps GRAPHICAL ABSTRACT Authors Lynn K. Debels1,2 , Tamas Tornai3,4, John T. Anderson5 , Maria E. Argenziano2,3,6, Anne Hoorens7, Vikash G. Lala8,9 , Pieter Jan Poortmans10,2 , Sander Smeets2,3 , Roland Valori5, Lobke Desomer2,11 , David J. Tate2,12 Institutions 1 Department of Gastroenterology and Hepatology, University Hospital Brussels, Anderlecht, Brussels, Belgium 2 Medicine and Health Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Flanders, Belgium 3 Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Flanders, Belgium 4 Institute of Pancreatic Diseases, Semmelweis University of Medicine, Budapest, Budapest, Hungary 5 Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, England, United Kingdom of Great Britain and Northern Ireland 6 Università Politecnica delle Marche, Ancona, Marche, Italy 7 Anatomopathology, University Hospital Ghent, Ghent, Flanders, Belgium 8 Department of Gastroenterology & Hepatology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, GP, South Africa 9 Department of Gastroenterology and Hepatology, Wits University Donald Gordon Medical Centre, Parkstown, South Africa 10 Gastroenterology and Hepatology, UZ Brussel, Brussels, Belgium 11 Gastroenterology, AZ Delta, Roeselare, Belgium 12 Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium Key words Endoscopy Lower GI Tract, Polyps / adenomas / ... , Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...), Quality and logistical aspects, Training, Colorectal cancer, Endoscopic resection (polypectomy, ESD, EMRc, ...) received 21.11.2025 accepted after revision 1.5.2026 accepted manuscript online 10.5.2026 Debels Lynn K et al. Teaching Six "blink"… Endosc Int Open 2026; 14: a28684812 | © 2026. The Author(s) . E1 Bibliography Endosc Int Open 2026; 14: a28684812 DOI 10.1055/a-2868-4812 ISSN 2364-3722 © 2026. The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Georg Thieme Verlag KG, Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany Corresponding author David J. Tate, MBBS MRCP (UK), MRCP (Gastro), Ghent University Faculty of Medicine and Health Sciences, Medicine and Health Sciences, Ghent, Flanders, Belgium [djtate@gmail.com](djtate@gmail.com) Supplementary Material is available at [https://doi.org/10.1055/a-2868-4812](https://doi.org/10.1055/a-2868-4812) ABSTRACT Background and study aims Accurate cancer detection in large non-pedunculated colorectal polyps (LNPCPs) remains challenging for general endoscopists. We evaluated whether teaching six gross morphological "blink" features could improve accuracy of cancer detection. Methods This prospective interventional study assessed general endoscopists evaluating 20 LNPCP images (7 with histologically confirmed submucosal invasive cancer includ- ing four deep invasions ≥ 1000 µm, 13 benign) . Participants assessed images before and after a 2-minute educational video introducing six blink features: spontaneous bleeding, depression, fold deformation, extra redness, ulceration, and chicken-skin mucosa. Primary outcome was change in miss-rate for cancer detection. Generalized linear mixed models accounted for clustering within raters and polyps. Results The 165 participants included gastroenterology consultants (63.6%), trainees (21.2%), students (1.8%) and colorectal surgeons (13.3%) with med

FAQs

What was the purpose of teaching the six “blink” features?

To determine whether training six gross morphological “blink” features could improve accuracy of cancer detection in image-based assessment of large non-pedunculated colorectal polyps.

How was the study designed and what did participants do?

A prospective interventional study assessed general endoscopists evaluating 20 LNPCP images before and after a 2-minute educational video introducing the six blink features.

Which blink features were identified as independent predictors of cancer?

Spontaneous bleeding, extra redness, and depression were independent predictors of cancer among general endoscopists in multivariable analysis.

Sep 23, 2026

Uploaded by Kurz