Association between visual gaze patterns and adenoma detection rate during colonoscopy: A preliminary investigation

Objectives: Eye gaze tracking (EGT) technology follows a person's gaze and records the resulting visual gaze pattern (VGP). Adenoma detection rate (ADR) is a validated measure of colonoscopy quality. Higher ADRs are associated with prolonged withdrawal times and other endoscopic maneuvers that allow a better visualization of the mucosa; however, the influence of VGP has yet to be explored. We aim to quantify the VGP for endoscopists observing colonoscopy videos and describe the association between VGP and ADR. Furthermore, we will evaluate the relationship between VGP and the endoscopists years of experience. Methods: Eleven endoscopists watched three videos while their VGP was recorded. The videos corresponded to 3 min of three different colonoscopy withdrawals. We divided the screen into a 3 × 3 grid of nine segments: eight peripheral and one central. We compared percent of gaze time (GT) in the central vs. peripheral segments using a paired t-test. VGP with ADR and years of practice were evaluated using Pearson's test. Results: Subjects spent more GT in the screen's central segment (65 vs. 33%, P0.001). ADR was significantly associated with increased percentage of central GT (r=0.67, P=0.024) and increased mean GT in the central segment (r=0.70, P=0.017). There was negative correlation between endoscopists years of practice and the percentage of central GT (r=0.67, P=0.025), but no correlation between years of practice and percentage of peripheral GT (r0.24, P0.47). Conclusions: This reveals an association between a centrally focused VGP and ADR. Future steps include confirming in a larger sample and exploring if VGP can retrain low ADR endoscopists to perform higher quality colonoscopies.