Implementation of Optical Diagnosis with a Resect and Discard Strategy for diminutive polyps in the English Bowel Cancer Screening Programme

Aims Optical diagnosis (OD) with a “resect and discard” strategy involves diagnosing diminutive polyps with high confidence, photodocumenting and resecting these without sending to histology. This greener, more efficient and cost-effective process underwent a comprehensive evaluation in the DISCARD3 study which showed, in a single screening centre, this meets the threshold for implementation and is feasible and safe with a quality assurance (QA) process in place. The NHS Bowel Cancer Screening Programme (NHSBCSP) in England approved implementation in 2023. Early learning from translating this research into a population based programme is presented.

Methods All 506 screening colonoscopists in England have been invited to undertake accreditation in OD. Part 1 of the process involves attendance at a training day including a pre- and post-training test where 120 polyps are optically diagnosed. Pass criteria is≥85% accuracy for high confidence optical diagnoses and overall≥50% high confidence calls. Part 2 involves supervised OD at each endoscopists’ base hospital of 20 consecutive high confidence, optical polyp diagnoses with assessment of photodocumentation quality and diagnostic accuracy. To pass part 2 photodocumentation quality is required to be adequate in≥90% of cases using the “3C photo quality score” and diagnosis accuracy≥85%. Once achieved, individuals are fully accredited to perform OD with a resect and discard strategy for screening cases and must undertake re-accreditation with online assessment of a further 120 polyp images every 2 years to demonstrate competency. Those accredited are supported by “Optical Diagnosis Champions” at each screening centre who monitor performance and support QA. Once in place “Optical Diagnosis Champions” will support those becoming accredited in OD [1].

Results 65 screening colonoscopists attended part 1 of the accreditation in March 2024. 85% (55/65) passed the post-test on the first attempt with a further 6 individuals passing on repeat attempts. Overall 61/65 (94%) have completed part 1. Of these, 43/61 (70%) have successfully completed part 2 and are fully accredited. As of November 2024, 2953 polyps have been resected and discarded with a cost saving equivalent to £109261 (assuming a cost of £37 per polyp). An estimated 984 hours of histopathology time has been saved (assuming 20 minutes per polyp). A second training day with 102 attendees in September 2024 has increased the total number of screening participants to a third of all screeners in England (167/506). The results from this will be reported in due course.

Conclusions The NHSBCSP is the first population based screening programme in the world to implement OD with a resect and discard strategy. Quality assurance and monitoring is ongoing. In this early stage there have already been cost and time savings for the NHS which are expected to increase substantially once roll out completes in 2027.

Conflicts of Interest

BPS has done consultancy and speaker work for Olympus. There are no other relevant current conflicts of interest to declare.

• References

• 1 Ahmad A. et al. Implementation of optical diagnosis with a “resect and discard” strategy in clinical practice: DISCARD3 study. Gastrointestinal Endoscopy 2022; 96 (06): 1021-1032.e2

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025