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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(05): E684-E692
DOI: 10.1055/a-1388-6694
Original article

Clinical validation of the SIMPLE classification for optical diagnosis of colorectal polyps

Ahmed Amine Alaoui‡
1   University of Montreal, Faculty of Medicine, Montreal, QC, Canada
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
,
Kussil Oumedjbeur‡
1   University of Montreal, Faculty of Medicine, Montreal, QC, Canada
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
,
Roupen Djinbachian
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
3   University of Montreal Hospital Center, Division of Internal Medicine, Montreal, QC, Canada
,
Étienne Marchand
1   University of Montreal, Faculty of Medicine, Montreal, QC, Canada
3   University of Montreal Hospital Center, Division of Internal Medicine, Montreal, QC, Canada
,
Paola N. Marques
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
4   Bahia State University, Faculty of Medicine, Salvador, Brazil
,
Mickael Bouin
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
6   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, QC, Canada
,
Simon Bouchard
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
6   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, QC, Canada
,
Daniel von Renteln
2   University of Montreal Hospital Centre Research Center, Gastroenterology, Montreal, QC, Canada
6   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, QC, Canada
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Abstract

Background and study aims A novel endoscopic optical diagnosis classification system (SIMPLE) has recently been developed. This study aimed to evaluate the SIMPLE classification in a clinical cohort.

Patients and methods All diminutive and small colorectal polyps found in a cohort of individuals undergoing screening, diagnostic, or surveillance colonoscopies underwent optical diagnosis using image-enhanced endoscopy (IEE) and the SIMPLE classification. The primary outcome was the agreement of surveillance intervals determined by optical diagnosis compared with pathology-based results for diminutive polyps. Secondary outcomes included the negative predictive value (NPV) for rectosigmoid adenomas, the percentage of pathology exams avoided, and the percentage of immediate surveillance interval recommendations. Analysis of optical diagnosis for polyps ≤ 10 mm was also performed.

Results 399 patients (median age 62.6 years; 55.6 % female) were enrolled. For patients with at least one polyp ≤ 5 mm undergoing optical diagnosis, agreement with pathology-based surveillance intervals was 93.5 % (95 % confidence interval [CI] 91.4–95.6). The NPV for rectosigmoid adenomas was 86.7 % (95 %CI 77.5–93.2). When using optical diagnosis, pathology analysis could be avoided in 61.5 % (95 %CI 56.9–66.2) of diminutive polyps, and post-colonoscopy surveillance intervals could be given immediately to 70.9 % (95 %CI 66.5–75.4) of patients. For patients with at least one ≤ 10 mm polyp, agreement with pathology-based surveillance intervals was 92.7 % (95 %CI 89.7–95.1). NPV for rectosigmoid adenomas ≤ 10 mm was 85.1 % (95 %CI CI 76.3–91.6).

Conclusions IEE with the SIMPLE classification achieved the quality benchmark for the resect and discard strategy; however, the NPV for rectosigmoid polyps requires improvement.

Supplementary material



Publication History

Received: 01 October 2020

Accepted: 20 January 2021

Article published online:
22 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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