“RESECT AND DISCARD” STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS

Aims:

“Resect and Discard” (RD) strategy is based on optic chromoendoscopy characterization of diminutive polyps (≤5 mm) histology without pathology assessment allowing cost savings in screening colonoscopy. According to ASGE recommendations this strategy could be applied if there is a ≥90% agreement in assignment of postpolypectomy surveillance intervals compared with conventional strategy. Our aim was to assess this strategy feasibility in our centre.

Methods:

Prospective, observational study of patients submitted to colonoscopy with optic chromoendoscopy during 12 months in one centre. Endoscopic (location, size, NICE classification and degree of confidence in this assessment) and pathological characteristics of polyps were collected. Postpolypectomy surveillance intervals were defined according to ESGE and ASGE/ACG/AGA recommendations. The primary objective was to compare the concordance of surveillance intervals between RD strategy and standard of care. We also compared NICE classification using optic chromoendoscopy and histology for each polyp.

Results:

203 colonoscopies with 595 polyps were included: 50% from the descending/sigmoid colon and rectum, with a mean size of 5.2 ± 3.7 mm. According to NICE classification, 47% of polyps were type I and 53% type II. Pathology revealed that 30% were hyperplastic polyps, 64% were adenomas, 2% were sessile serrated lesions and 4% were inflammatory changes. The endoscopic diagnosis using NICE classification for adenomatous histology had an accuracy of 80%, sensibility of 76%, specificity of 87%, positive predictive value of 92% and negative predictive value of 66%. The concordance of surveillance intervals between RD and conventional strategies was 93% according to ESGE guidelines and 84% based on ASGE/ACG/AGA recommendations. The surveillance intervals were longer in 16% (32/203) with RD strategy (in 22 patients the difference was between 5 – 10 and 10 years) and shorter in 2%.

Conclusions:

The RD strategy reached the ASGE recommended cut-off of agreement in surveillance intervals based on ESGE guidelines for postpolypectomy surveillance.