“Resect and pool”: Surveillance interval agreement, safety, and savings from placing all colorectal polyps considered zero risk of cancer in one container for pathologic assessment

Background and study aim: We investigated the effects of grouping all lesions (from all segments) deemed zero risk of cancer into a single bottle for pathology. Endpoints were proportion of correctly assigned surveillance intervals, safety (no cancers placed with lesions from other segments), and savings (through fewer bottles to pathology). Methods: We performed two prospective evaluations. In both phases the endoscopist assigned lesions as “zero-risk” (and eligible for pathologic assessment with zero-risk lesions from other segments) or “non-zero-risk” (requiring placement in its own bottle or with same segment lesions). In phase 1 resected lesions were placed in bottles from the same segment. The endoscopist predicted surveillance intervals based on lesion sizes, numbers and histology predictions. Predicted intervals were compared to pathology-based intervals. In phase 2 the “resect and pool” policy was implemented. Reduction in pathology bottles from combining zero-risk polyps from different segments was calculated. Results: In phase 1, 3514 lesions were deemed zero-risk, and none had cancer. Of 72 non-zero-risk lesions, 6 (8.3%) had cancer. Endoscopist surveillance intervals were correct in 97.2% (95% CI 95.7%,98.2%) of procedures, and 97.1% (95% CI 95.1%,98.4%) when intervals were determined only by lesions from the current colonoscopy. Phase 2 had 5107 zero-risk lesions, and none had cancer. Combining zero-risk lesions from different segments reduced pathology charges, and carbon footprint by 62-64% in patients with zero-risk lesions in multiple segments compared to if zero-risk lesions had been separated by colorectal segment. Conclusions: When performed by an endoscopist with expertise in optical diagnosis, resect and pool colonoscopy was safe, permitted correct prediction of surveillance intervals, and reduced pathology charges and carbon emissions.

Publikationsverlauf

Eingereicht: 30. Juni 2025

Angenommen nach Revision: 09. Dezember 2025

Accepted Manuscript online:
10. Dezember 2025