Colon to Rectum
Endoscopy. 2022;54(4):354–63
The location-based resect-and-discard strategy for diminutive colorectal polyps: A prospective clinical study
Background: Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator-dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator-dependent.
Methods: The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90% agreement with pathology in surveillance interval assignment.
Results: 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least 1 diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% confidence interval [CI]: 0.96–0.98), surpassing the ≥ 90% benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7% (95% CI: 0.67–0.72) reduction in pathology examinations compared with 55.3% (95% CI: 0.52–0.58; NICE and Sano) and 41.9% (95% CI: 0.39–0.45; WASP) with optical diagnosis.
Conclusion: The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90% benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.