Diminutive polyp cancers and the DISCARD strategy: Much ado about nothing or the end of the affair?

Wang, Lai Mun; East, James E.

doi:10.1016/j.gie.2015.02.036

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…The risk of interval cancer may also be compounded by inappropriately long surveillance intervals related to unrecognized rectosigmoid adenomas. This is represented by the doomsday scenario [14] of optical diagnosis in which patient harm is caused by human error. To our knowledge, no study has addressed patient preferences toward the "diagnose and leave" paradigm.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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

Sakata

Lee

Kheir

et al. 2017

Gastrointestinal Endoscopy

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…We explored the responses of patients to a so-called doomsday scenario [14]. Our patients were given a hypothetical scenario in which their endoscopist made a mistake and left behind a cancerous polyp, which resulted in the development of Stage III metastatic disease and a 5-year survival of 50%.…”

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confidence: 99%

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

Sakata

Lee

Kheir

et al. 2017

Gastrointestinal Endoscopy

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“…3 It is therefore proposed that alternative strategies may be explored, such as 'resect and discard' for proximal lesions or 'diagnose and leave' in the rectosigmoid, when managing low-risk polyps. 4 The benefits of this approach may include a reduced risk of adverse events, and reduced financial costs associated with colonoscopy, such as histopathology. 5 These alternative strategies require real-time assessment and prediction of polyp histology, and rely on the endoscopist being able to make a confident recognition of low-risk polyps.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis

Glover

Patel

Ashrafian

et al. 2018

Therap Adv Gastroenterol

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Objective:i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size.Data sources:The databases of Medline, Embase and the Cochrane Library were searched for relevant studies.Methods:A bivariate random effects model was used to produce pooled sensitivity and specificity values, and univariable meta-regression was applied for subgroup analysis.Results:The meta-analysis included 15 studies, and diagnosis of 2817 polyps. The area under the hierarchical summary receiver-operating characteristic curve was 0.96. The pooled sensitivity of i-scan optical diagnosis was 0.92 (95% confidence interval 0.85–0.95). The specificity was 0.90 (95% confidence interval 0.83–0.94).Conclusions:This meta-analysis updates and summarizes the available evidence concerning the diagnostic performance of i-scan for small colorectal polyps. An acceptable degree of accuracy was found, showing potential to support a ‘resect and discard’ strategy for colonic polyps. There was not found to be a significant difference in diagnostic performance between different clinical settings (i.e. teaching hospitals or general hospitals).

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“…Further, the resect-and-discard approach requires additional efforts by the endoscopist during the examination, added photo and text documentation, and the need to combine optical with pathology based diagnoses in a large proportion of patients. 31 This added complexity to everyday practice might further hinder widespread adoption. Alternative concepts to simplify the resect-and-discard strategy and minimize or eliminate the need for optical and histopathology assessment have recently been proposed.…”

Section: Introductionmentioning

confidence: 99%

Polyp Resection - Controversial Practices and Unanswered Questions

Renteln

Pohl

2017

Clinical and Translational Gastroenterology

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Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely >50%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps.

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Diminutive polyp cancers and the DISCARD strategy: Much ado about nothing or the end of the affair?

Cited by 10 publications

References 14 publications

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

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

Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis

Polyp Resection - Controversial Practices and Unanswered Questions

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