A Quantitative Analysis of Smartphone-Based Endoscopy and Video Tower Endoscopy

Objectives: Examine the differences between traditional tower-based endoscopy (TBE) and smartphone-based endoscopy (SBE) using objective measures of cost, setup time, and image quality. Methods: Cost analysis study and randomized single-blinded prospective trial was performed at a tertiary academic health center. Twenty-three healthcare providers, 2 PA-C, 9 residents, 2 fellows, 10 attendings varying in practice from 1 to 27 years were a part of the study. Actual cost analysis was used for purchase of the Karl Storz video tower system and the Save My Scope smartphone-based endoscopy system for cost analysis. For setup time, providers entered a room and were randomized to set up either an SBE or TBE system and timed from room entry to a visible on-screen image. A crossover was then performed so all providers performed both setups. For image discernment, standardized photos of a modified Snellen’s test were sent via text message to providers who were blinded as to which photo represented which system. Practitioners were randomized as to which photo to receive first. Results: Cost savings was 95.8% ($39,917 USD) per system. Setup time for the smartphone system was 46.7 seconds less than video tower system on average (61.5 vs 23.5 seconds; P <.001, 95% CI: 30.3-63.1 seconds). Level of visual discernment was slightly better for SBE over TBE, with reviewers able to identify Snellen test letters at a size of 4.2 mm with SBE versus 5.9 mm with TBE (P <.001). Conclusions: Smartphone-based endoscopy was found to be cheaper, quicker to set up, and to have marginally better image quality when transmitted via messaging than tower-based endoscopy, although the clinical significance of these visual differences are unknown. If appropriate for their needs, clinicians should consider smartphone-based endoscopy as a viable option for viewing and collaborating on endoscopic images from a fiberoptic endoscope.