Evaluation of the performance of a 'resect and discard' strategy for diminutive colon polyps

Aims Diminutive colonic polyps display a very low incidence of advanced histological features. European guidelines recommend their resection and subsequent histological evaluation, with the exception of rectosigmoid polyps when they can be characterized with high certainty as hyperplastic by using optical diagnosis. The 'resect and discard' technique involves the resection of polyps without a subsequent retrieval and histological examination. The aim of our study was to determine the frequency of advanced histological features (high-grade dysplasia in adenomas, dysplasia in serrated lesions) in diminutive colonic polyps.

Methods Patients who underwent resection of diminutive polyps (diameter≤0.5 cm) in the endoscopic laboratory of the First Propaedeutic Department of Internal Medicine of the Aristotle University of Thessaloniki between 1/2020 and 6/2024 were retrospectively recorded. Only patients for whom a histopathology report was available were included in the study.

Results A total of 173 patients with 229 polyps were included. The patients had a mean age of 64.7±10.9 years and were predominantly male (64.7%). The polyps had a mean diameter of 0.38±0.11 cm and were mainly located in the left colon (126, 55.1%). With regards to histological categorization, most of them were adenomatous (153, 66.8%), followed by hyperplastic (63, 27.5%) and serrated (13, 5.7%) polyps. Overall, 1/229 (0.4%) polyps developed advanced histological features (serrated polyp with dysplasia), leading to a shorter post-polypectomy surveillance interval.

Conclusions Diminutive colonic polyps have a significantly low probability of having advanced histological features. The utilization of a ‘resect and discard’ strategy, even without the use of optical diagnosis by chromoendoscopy, could be a safe alternative in this category of patients.

Publication History

Article published online:
27 March 2025