Evaluation of the polyp-based resect and discard strategy: a retrospective study

Abstract

Background: Standard colonoscopy practice requires removal and histological characterization of almost all small (<10 mm) and diminutive (≤5 mm) colorectal polyps found. The aim of this study was to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small and diminutive polyps, without the need for pathology. Methods: A post hoc analysis was performed on patients enrolled in a prospective colonoscopy study. The primary outcome was surveillance interval agreement of the PBRD strategy compared with pathology-based management according to the 2020 USMSTF guidelines. A chart analysis also evaluated clinician adherence to the pathology-based recommendations for included patients. One-sided testing was performed with a null-hypothesis of 90% agreement with pathology-based surveillance intervals and a two-sided 96.7% CI using correction for multiple testing. Results: 452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8% (96.7% CI [96.3% ; 99.3%]) of patients when comparing to pathology-based management. The PBRD strategy reduced pathological examinations by 58.7% while providing 87.8% of patients immediate surveillance interval recommendation on the day of the colonoscopy compared with 47.1% when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3% adherence to the pathology-based guideline. Conclusion: The PBRD strategy surpassed the 90% agreement with the pathology-based standard for determining subsequent colonoscopy surveillance interval. Furthermore, it reduced the need for pathological examinations and increased the proportion of patients receiving correct surveillance interval recommendations issued on the day of the colonoscopy. The PBRD strategy does not require any expertise in optical diagnosis and may replace any histological characterization of small and diminutive colorectal polyps.

Evaluating the Efficacy of Resect-and-Discard and Resect-and-Retrieve Strategies for Diminutive Colonic Polyps

“…In the second, post-procedural stage, it is decided whether retrieved polyps with dimensions between 3 mm and 5 mm are sent for a histopathological examination or are discarded, depending on the other two variables: the total number of polyps and the presence of polyps larger than 1 cm. Post hoc analysis showed that the accuracy of this algorithm was 98.6%, which far exceeded the advanced optical diagnosis accuracy of 71.6% that we reported, and is even higher than the AI-assisted NBI-trained expert accuracy of 90.2% previously reported in another study as well as the proposed 90% agreement with pathology-based management according to the 2020 US Multi-Society Task Force guidelines [23,24].…”

Specific Targeting and Labeling of Colonic Polyps in CPC-APC Mice with Mucin 5AC Fluorescent Antibodies: A Model for Detection of Early Colon Cancer

“…Conversely, if diminutive (<5 mm) polyps are identified during colonoscopy, many of them have benign pathology and pose little to no malignant potential. Because of this, many clinicians have proposed a pluck-and-discard strategy to avoid wasting medical resources for pathologic analysis [ 50 , 51 ]. However, this method has not yet become common practice due to the fear of missing small malignant polyps.…”

A Novel Computer-Aided Detection/Diagnosis System for Detection and Classification of Polyps in Colonoscopy

“…The 5-year survival rate of early stage CRC exceeds 90% with a well-established screening program [4]. The American Society for Gastrointestinal Endoscopy has proposed "resect and discard" and "diagnose and leave" strategies, suggesting that non-neoplastic polyps can be left unresected [5][6][7]. This strategy is based on real-time polyp classification, which is cost-effective and saves time for endoscopists.…”