During endoscopy, the resect and discard strategy, if performed with high confidence, can be used to determine histologic features of diminutive colorectal polyps (5 mm or less).
These polyps can then be removed and discarded without pathology assessment.
However, the complexities of real-time optical assessment and follow-up management have provided challenges to widespread use of this approach.
Dr Daniel von Renteln and colleagues from Canada determined the outcomes of simple alternative strategies, in which all diminutive polyps can be resected and discarded.
The team collected data from 2 previous studies that used narrow-band imaging to assess polyps, performed at 5 medical centers.
|Use of the simplified or location-based strategy could have avoided pathology analysis for 77% of all polyps|
|Clinical Gastroenterology & Hepatology|
The team compared 3 resect and discard strategies; the currently used optical strategy, which relies on high confidence optical assessment of all diminutive polyps; a location-based strategy that classifies all recto-sigmoid diminutive polyps a priori as hyperplastic and all polyps proximal to the recto-sigmoid colon a priori as neoplastic; and a simplified optical strategy, in which all recto-sigmoid diminutive polyps are classified as hyperplastic unless confidently assessed as neoplastic, and all polyps proximal to the recto-sigmoid colon are classified as neoplastic unless confidently assessed as hyperplastic polyps.
The researcher's primary outcome was the agreement of the surveillance interval calculated for each strategy with the surveillance interval determined by pathology analysis.
The proportion of surveillance intervals that agreed with pathology-based surveillance recommendations was slightly higher when the optical strategy was used compared to the location-based strategy or simplified optical strategy.
When the 5–10 year recommendations for patients with low-risk polyps were applied as a 10-year surveillance interval, all 3 strategies resulted in surveillance interval agreement compared to pathology above 90%.
Use of the simplified or location-based strategy could have avoided pathology analysis for 77% of all polyps, compared to 59% if the optical strategy was used.
In addition, a higher proportion of patients could receive recommendations immediately after colonoscopy with use of the simplified or location based strategy compared to the optical strategy.
Dr von Renteln's team comments, "A location-based and a simplified optical resect and discard strategy produced surveillance recommendations that were in agreement with those from pathology analysis for at least 90% of patients, assuming a 10-year surveillance interval for patients with low-risk polyps."
"These strategies could further reduce the number of pathology examinations and provide more patients with immediate surveillance recommendations."
"Optical assessment might be reduced or might not be required for resect and discard."