The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study

Abstract

Background Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent.

Methods The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment.

Results 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96–0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67–0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52–0.58; NICE and Sano) and 41.9 % (95 %CI 0.39–0.45; WASP) with optical diagnosis.

Conclusion The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.

Publikationsverlauf

Eingereicht: 02. Februar 2021

Angenommen nach Revision: 16. Juni 2021

Artikel online veröffentlicht:
26. August 2021

• References

• 1 Djinbachian R, Dube AJ, von Renteln D. Optical diagnosis of colorectal polyps: recent developments. Curr Treat Options Gastroenterol 2019; 17: 99-114
• 2 Gupta N, Bansal A, Rao D. et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 2012; 75: 1022-1030
• 3 Lieberman D, Moravec M, Holub J. et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135: 1100-1105
• 4 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1131-1153 e5
• 5 Chandran S, Parker F, Lontos S. et al. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals. Intern Med J 2015; 45: 1293-1299
• 6 Rex DK, Kahi C, O'Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
• 7 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 1155-1179
• 8 Rutter MD, East J, Rees CJ. et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69: 201-223
• 9 East JE, Vleugels JL, Roelandt P. et al. Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review. Endoscopy 2016; 48: 1029-1045
• 10 Rastogi A, Rao DS, Gupta N. et al. Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study. Gastrointest Endosc 2014; 79: 390-398
• 11 Ignjatovic A, Thomas-Gibson S, East JE. et al. Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps. Gastrointest Endosc 2011; 73: 128-133
• 12 Dekker E, Houwen B, Puig I. et al. Curriculum for optical diagnosis training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 899-923
• 13 Willems P, Djinbachian R, Ditisheim S. et al. Uptake and barriers for implementation of the resect and discard strategy: an international survey. Endosc Int Open 2020; 8: E684-E692
• 14 von Renteln D, Kaltenbach T, Rastogi A. et al. Simplifying resect and discard strategies for real-time assessment of diminutive colorectal polyps. Clin Gastroenterol Hepatol 2018; 16: 706-714
• 15 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
• 16 Jass JR, Sobin LH, Morson BC. Histological typing of intestinal tumours. 2nd edn. Berlin, New York: Springer-Verlag; 1989
• 17 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607 e1
• 18 Speert JEG, Bastiaansen BA, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
• 19 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69: 278-283
• 20 Katagiri A, Fu KI, Sano Y. et al. Narrow band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia. Aliment Pharmacol Ther 2008; 27: 1269-1274
• 21 Ikematsu H, Matsuda T, Emura F. et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 2010; 10: 33
• 22 Schachschal G, Mayr M, Treszl A. et al. Endoscopic versus histological characterisation of polyps during screening colonoscopy. Gut 2014; 63: 458-465
• 23 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 24 Bossuyt PM, Reitsma JB, Bruns DE. et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015; 351: h5527
• 25 Bordet M, Bretagne JF, Piette C. et al. Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. Gastrointest Endosc 2021; 93: 477-485
• 26 Paggi S, Rondonotti E, Amato A. et al. Resect and discard strategy in clinical practice: a prospective cohort study. Endoscopy 2012; 44: 899-904
• 27 Hong SN, Choe WH, Lee JH. et al. Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy. Gastrointest Endosc 2012; 75: 1011-1021 e2
• 28 Royero HG. La cromoendoscopia virtual i-Scan y su aplicación en la detección y caracterización de los pólipos de colon. Rev Colomb Gastroenterol 2017; 32: 31-37
• 29 Iacucci M, Trovato C, Daperno M. et al. Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps. Endoscopy 2018; 50: 779-789
• 30 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66: 887-895
• 31 Pigo F, Bertani H, Manno M. et al. i-Scan high-definition white light endoscopy and colorectal polyps: prediction of histology, interobserver and intraobserver agreement. Int J Colorectal Dis 2013; 28: 399-406
• 32 Von Renteln D, Leduc R, Bouchard S. et al. A78 Comparison of the Nice, Sano, and Wasp classifications for optical diagnosis of small colorectal polyps. JCAG 2020; 3 (Suppl. 01) 92-93
• 33 Byrne MF, Shahidi N, Rex DK. Will computer-aided detection and diagnosis revolutionize colonoscopy?. Gastroenterology 2017; 153: 1460-1464 e1
• 34 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
• 35 Djinbachian R, Dube AJ, Durand M. et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2019; 51: 673-683
• 36 Raghavendra M, Hewett DG, Rex DK. Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes. Gastrointest Endosc 2010; 72: 572-576
• 37 Alaoui A, Oumedjbeur K, Djinbachian R. et al. A79 Clinical validation of the simple classification for optical diagnosis of diminutive and small colorectal polyps. JCAG 2020; 3 (Suppl. 01) 93-94