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Identification of gaze pattern and blind spots by upper gastrointestinal endoscopy using an eye-tracking technique

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Abstract

Background

The lesion detection rate of esophagogastroduodenoscopy (EGD) varies depending on the degree of experience of the endoscopist and anatomical blind spots. This study aimed to identify gaze patterns and blind spots by analyzing the endoscopist’s gaze during real-time EGD.

Methods

Five endoscopists were enrolled in this study. The endoscopist’s eye gaze tracked by an eye tracker was selected from the esophagogastric junction to the second portion of the duodenum without the esophagus during insertion and withdrawal, and then matched with photos. Gaze patterns were visualized as a gaze plot, blind spot detection as a heatmap, observation time (OT), fixation duration (FD), and FD-to-OT ratio.

Results

The mean OT and FD were 11.10 ± 11.14 min and 8.37 ± 9.95 min, respectively, and the FD-to-OT ratio was 72.5%. A total of 34.3% of the time was spent observing the antrum. When observing the body of the stomach, it took longer to observe the high body in the retroflexion view and the low-to-mid body in the forward view.

Conclusions

It is necessary to minimize gaze distraction and observe the posterior wall in the retroflexion view. Our results suggest that eye-tracking techniques may be useful for future endoscopic training and education.

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Acknowledgements

The authors would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

No funding was received.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Ayoung Lee, Hyunsoo Chung, Jue Lie Kim, Jinju Choi, Eunwoo Lee, Bokyung Kim, Soo-Jeong Cho & Sang Gyun Kim

  2. Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea

    Ayoung Lee

  3. Seoul National University College of Medicine, Seoul, Republic of Korea

    Yejin Cho

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  1. Ayoung Lee
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Contributions

Each author’s individual contributions are as below: AL, YC, and HC analyzed and drafted the manuscript; AL and HC designed the study and edited the manuscript; HC, SC, and SGK provided critical revision of the manuscript for important intellectual content; YC, EL, and JLK provided statistical support; YC, HC, JC, BK, and SC provided data acquisition; HC and SGK supervised the study. All the authors approved the final manuscript.

Corresponding author

Correspondence to Hyunsoo Chung.

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Disclosures

The authors Ayoung Lee, Hyunsoo Chung, Yejin Cho, Jue Lie Kim, Jinju Choi, Eunwoo Lee, Bokyung Kim, Soo-Jeong Cho, and Sang Gyun Kim have no conflicts of interest or financial ties to disclose.

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Lee, A., Chung, H., Cho, Y. et al. Identification of gaze pattern and blind spots by upper gastrointestinal endoscopy using an eye-tracking technique. Surg Endosc 36, 2574–2581 (2022). https://doi.org/10.1007/s00464-021-08546-3

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