Resect and Discard Approach to Colon Polyps: Real-World Applicability Among Academic and Community Gastroenterologists

Hongha T. Vu, Gregory S. Sayuk, Thomas G. Hollander, Jennifer Clebanoff, Steven A. Edmundowicz, Chandra P. Gyawali, Erik P. Thyssen, Leonard B. Weinstock, Dayna S. Early

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: “Resect and discard” (RD) is a new paradigm for management of diminutive polyps.

Aim: To compare concordance of surveillance interval recommendations and diagnostic performance between RD and standard of care in a hospital outpatient department with both academic and community gastroenterologists.

Methods: Prospective, observational study conducted at a single outpatient endoscopy center over 12 months. Patients with diminutive polyps on screening or surveillance colonoscopy were included. Histology predictions for all diminutive polyps (≤5 mm) were made based on endoscopic imaging. Concordance of recommended surveillance intervals and diagnostic performance of histology predictions were compared to histopathological review.

Results: A total of 606 diminutive polyps were found in 315 patients (mean age 62.4 years, 49 % female). Histological prediction was made in 95.7 % of polyps (97.4 % of patients), with high confidence in 74.3 %. The concordance for surveillance intervals was 82.1 % compared to histopathological review and was similar between community and academic gastroenterologists (80.2 vs. 76.3 %, p = 0.38). Overall, sensitivity, specificity, and accuracy of histological predictions made with high confidence were 0.81, 0.36, and 77.1 %. Predictions made with narrow-band imaging (NBI) had lower accuracy (73.9 % with NBI vs. 82.5 % with high-definition white light (HWDL) only, p = 0.017) as well as lower prediction confidence (score of 7.6 with NBI vs. 8.6 with HDWL only, p < 0.001).

Conclusions: Our surveillance interval concordance was below the 90 % threshold deemed acceptable by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations statement. Diagnostic performance using optical imaging to predict histology was equal between community and academic endoscopists.

Original languageEnglish
Pages (from-to)502-508
Number of pages7
JournalDigestive diseases and sciences
Volume60
Issue number2
DOIs
StatePublished - Jan 23 2015

Keywords

  • Adenoma
  • Colonoscopy
  • Polyp
  • Resect and discard

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