A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps

Abstract

Endoscopic diagnosis of polyp histology during colonoscopy and forgoing pathologic examination would result in substantial up-front cost savings. Downstream consequences of the resulting incorrect surveillance intervals appear to be negligible.

S3-Leitlinie – Kolorektales Karzinom

“…Es gibt zahlreiche Veröffentlichungen zu der Überlegung einer endoskopischen Polypendifferenzialdiagnose ("endoskopische Histologie") [491] mit dem Ziel, kleinere abgetragene Polypen nicht mehr histologisch untersuchen zu lassen ("Resect and Discard" [493,494], kurz DISCARD policy) -vorwiegend aus Kostengründen [495,496]. Die Nachsorgeempfehlungen richten sich dann hauptsächlich nach der endoskopischen Differenzialdiagnose zwischen Adenomen und hyperplastischen Läsionen, da keine Histologie mehr vorliegt.…”

Patient acceptance of the optical diagnosis and misdiagnosis of diminutive colorectal polyps

“…[6][7][8] As diminutive colorectal polyps make up the majority of detected polyps at colonoscopy, the adoption of optical diagnosis is estimated confer a savings of USD$33 million per year in the United States alone. [6] However, widespread implementation of optical diagnosis in clinical practice hinges on widespread patient acceptance.…”

Quality Assurance in Endoscopy: Which Parameters?

“…The histological evaluation of resected polyps should be considered as standard with regard to the current standard of knowledge. However, in Anglo-American countries, it has been suggested that due to cost reasons [54,55] polyps should be resected but not analysed histologically (‘resect and discard', shortly DISCARD). Up to now, this policy is limited to polyps of less than 5 mm for risk assessment reasons.…”