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Endoscopy 2022; 54(02): 128-135
DOI: 10.1055/a-1386-7434
Original article

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

Antoine Duong
1   Department of Family Medicine, McGill University, Montreal, Quebec, Canada
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
,
Heiko Pohl
3   Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States
4   Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, United States
,
Roupen Djinbachian
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
5   Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Annie Deshêtres
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
5   Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Alan N. Barkun
6   Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
,
Paola N. Marques
7   Faculty of Medicine, Bahia State University, Salvador, Bahia, Brazil
,
Mickael Bouin
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
8   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Eric Deslandres
8   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Andres Aguilera-Fish
3   Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States
4   Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, United States
,
Raymond Leduc
8   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
,
Daniel von Renteln 
2   University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
8   Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
› Author AffiliationsTrial Registration: The Non-Optical Resect and Discard Study (ClinicalTrials.gov) Registration number (trial ID): NCT04032912 Type of study: Prospective
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The resect and discard strategy: a new kid on the block?Endoscopy 2022; 54(02): 136-137
DOI: 10.1055/a-1493-2749

Abstract

Background Standard colonoscopy practice requires removal and histological characterization of almost all detected small (< 10 mm) and diminutive (≤ 5 mm) colorectal polyps. This study aimed to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small/diminutive polyps, without the need for pathology examination.

Methods A post hoc analysis was performed on patients enrolled in a prospective study. The primary outcome was surveillance interval agreement of the PBRD strategy with pathology-based management according to 2020 US Multi-Society Task Force guidelines. Chart analysis also evaluated clinician adherence to pathology-based recommendations. One-sided testing was performed with a null-hypothesis of 90 % agreement with pathology-based surveillance intervals and a two-sided 96.7 % confidence interval (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 compared with pathology-based management. The PBRD strategy reduced pathology examinations by 58.7 % while providing 87.8 % of patients with immediate surveillance interval recommendations on the day of colonoscopy, compared with 47.1 % when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3 % adherence to pathology-based guidelines.

Conclusion The PBRD strategy surpassed the 90 % agreement with the pathology-based standard for determining surveillance interval, reduced the need for pathology examinations, and increased the proportion of patients receiving immediate surveillance interval recommendations. The PBRD strategy does not require expertise in optical diagnosis and may replace histological characterization of small and diminutive colorectal polyps.

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Publication History

Received: 15 February 2020

Accepted: 09 February 2021

Accepted Manuscript online:
09 February 2021

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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