Should We Resect and Discard Low Risk Diminutive Colon Polyps

Abstract

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.

Colon capsule endoscopy in colorectal cancer screening: a randomised controlled trial

“…The polypectomy of low-risk polyps in regular colonoscopy based screening may therefore be considered as redundant and may pose a risk to the patient. 30 Participants with suspected low-risk polyps will return to biennial screening. By doing so, we expect to reduce the number of participants having to undergo a follow-up colonoscopy by approximately 20% and we may be able to follow the natural cause of suspected low-risk polyps left behind.…”

Clinical validation of the SIMPLE classification for optical diagnosis of colorectal polyps

“…Such use of IEE instead of pathology is referred to as the "resect and discard strategy" [12][13][14]. Clinical implementation of this approach would reduce colonoscopy-associated costs [1,10].…”

How to safely apply a 'Resect and Discard' policy for small colorectal polyps–real‐world data comparing endoscopic polyp evaluation and subsequent histological outcome

“…Many observational studies suggest that endoscopic polypectomy reduces cancer mortality 14,15 . However, given that more than 90% of colorectal polyps are ≤9 mm and approximately 50% are non‐neoplastic, with only 1.7% of cases having advanced histology suggestive of potential progression to malignancy, 11 polypectomies may expose patients to unnecessary risks during colonoscopy 16 . Subsequently, recent studies have explored the use of optical diagnosis, encouraging small hyperplastic polyps to be left in situ (diagnose and leave) and resecting small adenomas without formal histology (resect and discard) 16‐18 .…”

“…Subsequently, recent studies have explored the use of optical diagnosis, encouraging small hyperplastic polyps to be left in situ (diagnose and leave) and resecting small adenomas without formal histology (resect and discard) 16‐18 . This serves to reduce procedural time and screening costs 16 …”