The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study

Abstract

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 one 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.

Trial registration: ClinicalTrials.gov NCT04032912.

Conflict of interest statement

Daniel von Renteln is supported by the “Fonds de Recherche du Québec Santé” career development award and has received research funding from ERBE, Ventage, Pendopharm and Pentax and is a consultant for Boston Scientific and Pendopharm. The findings, statements, and views expressed are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States Government.

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