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Endoscopy 2022; 54(04): 354-363
DOI: 10.1055/a-1546-9169
Original article

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

Mahsa Taghiakbari
1   University of Montréal, Montréal, Quebec, Canada
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
,
Heiko Pohl
3   Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA
4   Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, USA
,
Roupen Djinbachian
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
5   Division of Internal Medicine, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Alan Barkun
6   Division of Gastroenterology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
,
Paola Marques
7   Faculty of Medicine, Bahia State University, Salvador, Bahia, Brazil
,
Mickael Bouin
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Eric Deslandres
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Benoit Panzini
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Simon Bouchard
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Audrey Weber
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
,
Daniel von Renteln 
2   University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
8   Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04032912 Type of study: Prospective
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Is a location-based resect-and-discard strategy the right approach?Endoscopy 2022; 54(04): 434-434
DOI: 10.1055/a-1737-3901

Referred to by:

Making a resect-and-discard strategy work for diminutive colorectal polyps: let's get realEndoscopy 2022; 54(04): 364-366
DOI: 10.1055/a-1616-0659

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.

Fig. 1 s, Tables 1 s, 2 s



Publication History

Received: 02 February 2021

Accepted after revision: 16 June 2021

Article published online:
26 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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