Background and study aims: Narrow-band imaging (NBI) has shown promising results in discriminating adenomatous
from non-adenomatous colonic polyps. In patients with small polyps (< 10 mm), the
application of NBI within a “resect and discard” strategy, might allow post-polypectomy
surveillance intervals to be determined independently from histopathology. The aim
of the present study was to assess the feasibility and safety of this approach in
routine clinical practice.
Patients and methods: Consecutive colonoscopy outpatients with one or more polyps smaller than 10 mm were
prospectively included. Each polyp was categorized by the endoscopist as adenoma or
non-adenoma according to simplified NBI criteria, and future post-polypectomy surveillance
interval was assigned accordingly. Following histopathology, post-polypectomy surveillance
interval was subsequently re-assigned, and the accordance between endoscopy- and histology-directed
surveillance strategies was calculated.
Results: Among 942 colonoscopy patients, 286 (30.4 %) with only small polyps were included.
In total, 511 small polyps were evaluated; 350 (68.5 %) were adenomas and 18 of these
(5.1 %) had histologic features of advanced neoplasia. For the in vivo diagnosis of
adenoma, NBI sensitivity, specificity, accuracy, and positive and negative likelihood
ratios were 94.9 %, 65.8 %, 85.7 %, 2.80, and 0.08, respectively. The endoscopy-directed
surveillance strategy was in accordance with the histology-directed strategy in 237
of 286 patients (82.9 %). In 9.8 % and 7.3 % patients, the endoscopy-directed approach
would have resulted in early and delayed surveillance, respectively.
Conclusions: The resect and discard strategy seems to be a viable, safe, and cost-effective approach
for the management of patients with small polyps. However, caution in the application
of the strategy should be advocated for patients with polyps 6 – 9 mm in size and
those with right-sided lesions, due to their malignant potential.
The study was registered on Clinicaltrials.gov (NCT01462123).
