Endoscopy 2022; 54(01): 27-34
DOI: 10.1055/a-1328-5405
Original article

The “diagnose and leave in” strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial

 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
Aleksandar Gavric*
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 3  University Medical Centre Ljubljana, Department of Gastroenterology and Hepatology Ljubljana, Slovenia
,
Jesús Herrero
 4  Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Gastroenterology, Ourense, Spain
,
David Remedios
 4  Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, CIBERehd, Gastroenterology, Ourense, Spain
,
Victoria Alvarez
 5  Complexo Hospitalario de Pontevedra, Digestive Department, Pontevedra, Spain
,
 6  Complejo Hospitalario de Navarra, Digestive System Service, Endoscopy Unit, Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
,
Jordi Gordillo
 7  Hospital de la Santa Creu i Sant Pau, Gastroenterology Unit, Barcelona, Spain
,
 8  Althaia, Xarxa Assistencial Universitària de Manresa, Gastroenterology Department, Manresa, Spain
,
Jorge López-Vicente
 9  Hospital Universitario de Móstoles, Digestive System Service, Móstoles, Madrid, Spain
,
Alain Huerta
10  Hospital Galdakao-Usansolo, Department of Gastroenterology, Galdakao, Spain
,
María López-Cerón
11  Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
,
Inmaculada Salces
11  Hospital Universitario 12 de Octubre, Digestive System Service, Madrid, Spain
,
Beatriz Peñas
12  Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain
13  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
,
Sofía Parejo
12  Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain
,
Enrique Rodriguez
12  Hospital Universitario Ramon y Cajal, Department of Gastroenterology, Madrid, Spain
13  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
,
Maite Herraiz
14  University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
,
Cristina Carretero
14  University of Navarra Clinic-IdiSNA, Gastroenterology Department, Pamplona, Spain
,
Antonio Z. Gimeno-Garcia
15  Hospital Universitario de Canarias, Gastroenterology Department, Santa Cruz de Tenerife, Spain
,
Esteban Saperas
16  Hospital General de Catalunya, Gastroenterology Department, Sant Cugat del Vallès, Spain
,
Cristina Alvarez
17  Hospital del Mar, Gastroenterology Department, Barcelona, Spain
,
Coral Arnau-Collell
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
,
Oswaldo Ortiz
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
Ariadna Sánchez
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
Francesc Balaguer
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
,
 1  Hospital Clinic de Barcelona, Department of Gastroenterology, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
 2  Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
› Author Affiliations
Supported by: Fundación Científica Asociación Española Contra el Cáncer GCB13131592CAST
Supported by: Societat Catalana de Digestologia, Beca d’Iniciació a la Recerca 2016, Agència de Gestió d’Ajuts Universitaris i de Recerca 2017 SGR 653
Supported by: Instituto de Salud Carlos III PI16/00766

Abstract

Background The “diagnose-and-leave-in” policy has been established to reduce the risks and costs related to unnecessary polypectomies in the average-risk population. In individuals with Lynch syndrome, owing to accelerated carcinogenesis, the general recommendation is to remove all polyps, irrespective of size, location, and appearance. We evaluated the feasibility and safety of the diagnose-and-leave-in strategy in individuals with Lynch syndrome.

Methods We performed a post hoc analysis based on per-polyp data from a randomized, clinical trial conducted by 24 dedicated colonoscopists at 14 academic centers, in which 256 patients with confirmed Lynch syndrome underwent surveillance colonoscopy from July 2016 to January 2018. In vivo optical diagnosis with confidence level for all detected lesions was obtained before polypectomy using virtual chromoendoscopy alone or with dye-based chromoendoscopy. Primary outcome was the negative predictive value (NPV) for neoplasia of high-confidence optical diagnosis among diminutive (≤ 5 mm) rectosigmoid lesions. Histology was the reference standard.

Results Of 147 rectosigmoid lesions, 128 were diminutive. In 103 of the 128 lesions (81 %), the optical diagnostic confidence was high and showed an NPV of 96.0 % (95 % confidence interval [CI] 88.9 %–98.6 %) and accuracy of 89.3 % (95 %CI 81.9 %–93.9 %). By following the diagnose-and-leave-in policy, we would have avoided 59 % (75/128) of polypectomies at the expense of two diminutive low grade dysplastic adenomas and one diminutive sessile serrated lesion that would have been left in situ.

Conclusion In patients with Lynch syndrome, the diagnose-and-leave-in strategy for diminutive rectosigmoid polyps would be feasible and safe.

* These authors contributed equally to this work.


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Publication History

Received: 19 March 2020

Accepted after revision: 03 December 2020

Publication Date:
03 December 2020 (online)

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