Measurement in endoscopy and SCALE EYE

Why size measurement matters

Professor Daniel von Renteln

When it comes to polyps, size really does matter, because it influences a lot of our decision-making processes as endoscopists. A lot of what we do – how we resect polyps, when we ask the patient to come back – is based on how we estimate polyp size. Historically we’ve never had an accurate means of measuring.

It’s like if you ask people how to estimate their height and weight instead of being able to take it accurately. Clinically important decisions are based on these measurements, and for the last 30 or 40 years we’ve accepted the lack of consistency. We’ve had a few tools like endoscopic rulers, but they’re cumbersome to use, and time-consuming, so they never really caught on and are unfeasible.

SCALE EYE is the first device of a new era. There are different ways in which this problem of measurement will be solved, but this is the first one to measure size objectively. The studies we’ve done so far show that it does what it’s supposed to do. It’s not surprising; any ruler or means of objective measurement is better than our subjective vision.

As I have recently discussed in my symposium at the European Society for Gastroenterology’s annual congress, ESGE Days, measurement is also important because it affects clinical decision-making. For example, generally, if a polyp is more than 10mm, management will involve the patient having to come back earlier to be checked; if it’s smaller, then the follow up can be very different. In principle, if we base a decision on size, we should have a tool that allows us to measure size objectively.

Another advantage of SCALE EYE is its ease of use. I can simply press a button on the endoscope to activate SCALE EYE – I don’t have to use a separate single use instrument.

There is a barrier to overcome, which is that devices such as this need to be widely available. Clinicians may also have a certain way of measuring and may want to be reassured that this technology does not replace them as clinical experts; on the contrary, new solutions such as SCALE EYE support their decision-making and enhance it, rather than challenging it. One study we did recently examined the way in which experts estimate polyp size based on videos, and even experts improved their measurement if they used SCALE EYE.

Finally, what I hope is that now that we have the first product of its kind with SCALE EYE, this will create a technology push, so five years down the road we will have more, and different, solutions. My prediction is that these solutions will become standard in a couple of years, which can only be a positive step forward for endoscopy.