CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(05): E684-E692
DOI: 10.1055/a-1132-5371
Original article

Uptake and barriers for implementation of the resect and discard strategy: an international survey

Philippe Willems
1  Division of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, Canada
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
,
Roupen Djinbachian
1  Division of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, Canada
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
,
Saskia Ditisheim
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
3  Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Sinan Orkut
4  Faculty of Medicine, University of Strasbourg, Strasbourg, France
,
Heiko Pohl
5  Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
,
Alan Barkun
6  Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
,
Mickael Bouin
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
3  Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Bernard Faulques
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
3  Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Daniel von Renteln
2  Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
3  Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
› Author Affiliations
  

Abstract

Background and study aims Optical real-time diagnosis (= resect-and-discard strategy) is an alternative to histopathology for diminutive colorectal polyps. However, clinical adoption of this approach seems sparse. We were interested in evaluating potential clinical uptake and barriers for implementation of this approach.

Methods We conducted an international survey using the “Google forms” platform. Nine endoscopy societies distributed the survey. Survey questions measured current clinical uptake and barriers for implementing the resect-and-discard strategy, perceived cancer risk associated with diminutive polyps and potential concerns with using CT-colonography as follow-up, as well as non-resection of diminutive polyps.

Results Eight hundred and eight endoscopists participated in the survey. 84.2 % (95 % CI 81.6 %–86.7 %) of endoscopists are currently not using the resect-and-discard strategy and 59.9 % (95 % CI 56.5 %–63.2 %) do not believe that the resect-and-discard strategy is feasible for implementation in its current form. European (38.5 %) and Asian (45 %) endoscopists had the highest rates of resect-and-discard practice, while Canadian (13.8 %) and American (5.1 %) endoscopists had some of the lowest implementation rates. 80.3 % (95 % CI 77.5 %–83.0 %) of endoscopists believe that using the resect-and-discard strategy for diminutive polyps will not increase cancer risk. 48.4 % (95 % CI 45.0 %–51.9 %) of endoscopists believe that leaving diminutive polyps in place is associated with increased cancer risk. This proportion was slightly higher (54.7 %; 95 % CI 53.6 %–60.4 %) when asked if current CT-colonography screening practice might increase cancer risks.

Conclusion Clinical uptake of resect-and-discard is very low. Most endoscopists believe that resect-and-discard is not feasible for clinical implementation in its current form. The most important barriers for implementation are fear of making an incorrect diagnosis, assigning incorrect surveillance intervals and medico-legal consequences.

Supplementary material



Publication History

Received: 21 November 2019

Accepted: 04 February 2019

Publication Date:
17 April 2020 (online)

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