Are Gastroenterologists Willing to Implement the “Predict, Resect, and Discard” Management Strategy for Diminutive Colorectal Polyps?

Soudagar, A. Samad; Nguyen, Minh; Bhatia, Arvin; Rastogi, Amit; Gupta, Neil

doi:10.1097/mcg.0000000000000382

Cited by 14 publications

(6 citation statements)

References 13 publications

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“…Of all endoscopists, 44.6 % were afraid of making a wrong diagnosis, 53.8 % were concerned about potential medicolegal issues, and 58.3 % were afraid of assigning incorrect surveillance intervals to patients. These findings are similar to those of Soudagar et al in 2016, where medicolegal concerns were the main barrier to implementation of the resect-and-discard strategy for the 105 gastroenterologists surveyed during a national conference in the USA [40]. While the consensus for most regions was that resect-and-discard was not feasible, 54 % of the European endoscopists showed an increased adoption of the strategy.…”

Section: Risk Of Metastatic Disease After Resecting and Discarding A Diminutive Lesion With Cancersupporting

confidence: 88%

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2021

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Background The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 – 5 mm). Methods A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. Recommendation 1 In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. Recommendation 2 In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1–5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1–5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. Conclusion The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.

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Section: Risk Of Metastatic Disease After Resecting and Discarding A Diminutive Lesion With Cancersupporting

confidence: 88%

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

et al. 2021

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“…The most important reasons why the resect-and-discard strategy was not feasible included fear of making an incorrect diagnosis leading to incorrect surveillance interval assignment and medicolegal issues. Our results were similar to those found by Soudagar et al 2016, where medicolegal concerns were the main barrier for implementation of the resect-and-discard strategy for the 105 Gastroenterologists surveyed during a national conference in the United States [14]. These reasons seem to point towards a concern of potential interval CRCs when using a resect-and-discard strategy, however, 80.3 % of endoscopists voiced the opinion that a resect-and-discard strategy would not increase CRC risk.…”

Section: Questionssupporting

confidence: 87%

Uptake and barriers for implementation of the resect and discard strategy: an international survey

Willems¹,

Djinbachian²,

Ditisheim³

et al. 2020

Endosc Int Open

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Background and study aims Optical real-time diagnosis (= resect-and-discard strategy) is an alternative to histopathology for diminutive colorectal polyps. However, clinical adoption of this approach seems sparse. We were interested in evaluating potential clinical uptake and barriers for implementation of this approach. Methods We conducted an international survey using the “Google forms” platform. Nine endoscopy societies distributed the survey. Survey questions measured current clinical uptake and barriers for implementing the resect-and-discard strategy, perceived cancer risk associated with diminutive polyps and potential concerns with using CT-colonography as follow-up, as well as non-resection of diminutive polyps. Results Eight hundred and eight endoscopists participated in the survey. 84.2 % (95 % CI 81.6 %–86.7 %) of endoscopists are currently not using the resect-and-discard strategy and 59.9 % (95 % CI 56.5 %–63.2 %) do not believe that the resect-and-discard strategy is feasible for implementation in its current form. European (38.5 %) and Asian (45 %) endoscopists had the highest rates of resect-and-discard practice, while Canadian (13.8 %) and American (5.1 %) endoscopists had some of the lowest implementation rates. 80.3 % (95 % CI 77.5 %–83.0 %) of endoscopists believe that using the resect-and-discard strategy for diminutive polyps will not increase cancer risk. 48.4 % (95 % CI 45.0 %–51.9 %) of endoscopists believe that leaving diminutive polyps in place is associated with increased cancer risk. This proportion was slightly higher (54.7 %; 95 % CI 53.6 %–60.4 %) when asked if current CT-colonography screening practice might increase cancer risks. Conclusion Clinical uptake of resect-and-discard is very low. Most endoscopists believe that resect-and-discard is not feasible for clinical implementation in its current form. The most important barriers for implementation are fear of making an incorrect diagnosis, assigning incorrect surveillance intervals and medico-legal consequences.

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“…One paper estimated that the strategy could save 33 million dollars per year in the United States 18 . Survey data suggest a potentially high acceptance rate among endoscopists and patients 19–21 . A meta-analysis conducted as part of the American Society for the Gastrointestinal Endoscopy (ASGE) effort, “Preservation and Incorporation of Valuable Endoscopic Innovation” (PIVI), demonstrated a high negative predictive value (93%) for adenomatous polyp histology when the endoscopist used narrow band imaging technology (NBI) and had a high confidence level for the strategy 22–24 .…”

Section: Discussionmentioning

confidence: 99%

Can the Sum of Adenoma Diameters (Adenoma Bulk) on Index Examination Predict Risk of Metachronous Advanced Neoplasia?

Anderson

Morris

Robertson

et al. 2018

Journal of Clinical Gastroenterology

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Are Gastroenterologists Willing to Implement the “Predict, Resect, and Discard” Management Strategy for Diminutive Colorectal Polyps?

Abstract: Approximately two-thirds of gastroenterologists are willing to adopt the "predict, resect, and discard" strategy for managing diminutive colon polyps. Medical-legal concerns and lack of financial incentives are the primary barriers to implementation.

Cited by 14 publications

References 13 publications

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Uptake and barriers for implementation of the resect and discard strategy: an international survey

Can the Sum of Adenoma Diameters (Adenoma Bulk) on Index Examination Predict Risk of Metachronous Advanced Neoplasia?

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