Optical Diagnosis of Colorectal Polyps: Recent Developments

Djinbachian, Roupen; Dubé, Anne-Isabelle; Renteln, Daniel von

doi:10.1007/s11938-019-00220-x

Cited by 20 publications

(22 citation statements)

References 61 publications

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“…Improved polypectomy technique is clearly needed, and the results from the Italian EMR study [15] indicate that cold snare polypectomy may be a good choice for these polyps and should be tested in randomized trials. Furthermore, modern technology such as computer-assisted technology, snare tip soft coagulation, and chromoendoscopy [21][22][23] may also be helpful in identifying and completely removing SSA/Ps, as well as in determining their extent in the colon mucosa.…”

Section: Endoscopistmentioning

confidence: 99%

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

et al. 2020

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Background Endoscopic screening with polypectomy has been shown to reduce colorectal cancer incidence in randomized trials. Incomplete polyp removal and subsequent development of post-colonoscopy cancers may attenuate the effect of screening. This study aimed to quantify the extent of incomplete polyp removal. Methods We included patients aged 50–75 years with nonpedunculated polyps ≥ 5 mm removed during colonoscopy at four hospitals in Norway. To evaluate completeness of polyp removal, biopsies from the resection margins were obtained after polypectomy. Logistic regression models were fitted to identify factors explaining incomplete resection. Results 246 patients with 339 polyps underwent polypectomy between January 2015 and June 2017. A total of 12 polyps were excluded due to biopsy electrocautery damage, and 327 polyps in 246 patients (mean age 67 years [range 42–83]; 52 % male) were included in the analysis. Overall, 54 polyps (15.9 %) in 54 patients were incompletely resected. Histological diagnosis of the polyp (sessile serrated lesions vs. adenoma, odds ratio [OR] 10.9, 95 % confidence interval [CI] 3.9–30.1) and polyp location (proximal vs. distal colon, OR 2.8, 95 %CI 1.0–7.7) were independent risk factors for incomplete removal of polyps 5–19 mm. Board-certified endoscopists were not associated with lower rates of incomplete resection compared with trainees (14.0 % vs. 14.2 %), OR 1.0 (95 %CI 0.5–2.1). Conclusion Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees.

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Section: Endoscopistmentioning

confidence: 99%

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

et al. 2020

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“…Most gastroenterology and endoscopy societies across the world have not yet officially made statements on resect-and-discard in their guidelines because of this contradictory data, contributing to the low implementation rate we found in this study. Further, recent research in imaging technologies and optical diagnosis have led to the emergence of many optical diagnosisbased classification systems, each with their own criteria, which can be confusing and overwhelming for endoscopists [17]. Our survey shows a definite concern from endoscopists about the feasibility of making optical diagnoses and highlights the need for simplifying decision-making or removing the need for optical diagnosis altogether [18].…”

Section: Questionsmentioning

confidence: 92%

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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“…CAD–CNN models for colonoscopy could assist endoscopists in detecting polyps and performing optical diagnosis [17,18,19]. These AI-based models have great potential for increasing the adenoma detection rate (ADR) and reducing the cost of polypectomy for hyperplastic polyps [18,20,21]. CNNs are trained using thousands of colonoscopy images to identify and differentiate between hyperplastic and adenomatous polyps [17,20,21,22,23].…”

Section: Computer-aided Diagnosismentioning

confidence: 99%

“…These AI-based models have great potential for increasing the adenoma detection rate (ADR) and reducing the cost of polypectomy for hyperplastic polyps [18,20,21]. CNNs are trained using thousands of colonoscopy images to identify and differentiate between hyperplastic and adenomatous polyps [17,20,21,22,23]. In order to be maximally effective, the polyp identification module should have a high sensitivity for the detection of polyps, with low rate of false positives, while maintaining fast processing speeds to be applicable in near-real time during colonoscopy.…”

Section: Computer-aided Diagnosismentioning

confidence: 99%

Application of Artificial Intelligence in the Detection and Differentiation of Colon Polyps: A Technical Review for Physicians

2019

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Research in computer-aided diagnosis (CAD) and the application of artificial intelligence (AI) in the endoscopic evaluation of the gastrointestinal tract is novel. Since colonoscopy and detection of polyps can decrease the risk of colon cancer, it is recommended by multiple national and international societies. However, the procedure of colonoscopy is performed by humans where there are significant interoperator and interpatient variations, and hence, the risk of missing detection of adenomatous polyps. Early studies involving CAD and AI for the detection and differentiation of polyps show great promise. In this appraisal, we review existing scientific aspects of AI in CAD of colon polyps and discuss the pitfalls and future directions for advancing the science. This review addresses the technical intricacies in a manner that physicians can comprehend to promote a better understanding of this novel application.

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Optical Diagnosis of Colorectal Polyps: Recent Developments

Cited by 20 publications

References 61 publications

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

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

Application of Artificial Intelligence in the Detection and Differentiation of Colon Polyps: A Technical Review for Physicians

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