Uptake and barriers for implementation of the resect and discard strategy: an international survey

Abstract

Background and study aims Optical real-time diagnosis (= resect-and-discard strategy) is an alternative to histopathology for diminutive colorectal polyps. However, clinical adoption of this approach seems sparse. We were interested in evaluating potential clinical uptake and barriers for implementation of this approach. Methods We conducted an international survey using the “Google forms” platform. Nine endoscopy societies distributed the survey. Survey questions measured current clinical uptake and barriers for implementing the resect-and-discard strategy, perceived cancer risk associated with diminutive polyps and potential concerns with using CT-colonography as follow-up, as well as non-resection of diminutive polyps. Results Eight hundred and eight endoscopists participated in the survey. 84.2 % (95 % CI 81.6 %–86.7 %) of endoscopists are currently not using the resect-and-discard strategy and 59.9 % (95 % CI 56.5 %–63.2 %) do not believe that the resect-and-discard strategy is feasible for implementation in its current form. European (38.5 %) and Asian (45 %) endoscopists had the highest rates of resect-and-discard practice, while Canadian (13.8 %) and American (5.1 %) endoscopists had some of the lowest implementation rates. 80.3 % (95 % CI 77.5 %–83.0 %) of endoscopists believe that using the resect-and-discard strategy for diminutive polyps will not increase cancer risk. 48.4 % (95 % CI 45.0 %–51.9 %) of endoscopists believe that leaving diminutive polyps in place is associated with increased cancer risk. This proportion was slightly higher (54.7 %; 95 % CI 53.6 %–60.4 %) when asked if current CT-colonography screening practice might increase cancer risks. Conclusion Clinical uptake of resect-and-discard is very low. Most endoscopists believe that resect-and-discard is not feasible for clinical implementation in its current form. The most important barriers for implementation are fear of making an incorrect diagnosis, assigning incorrect surveillance intervals and medico-legal consequences.

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

“…Attitudes of endoscopists and patients with regards to a leave-in-situ strategy Willems et al performed an international survey among 808 endoscopists from nine endoscopy societies to evaluate their attitudes and practices with regards to a leave-in-situ strategy [34] In total, 63 % of the participants partly or completely agreed that diminutive polyps could be left unresected until the next screening colonoscopy because of the low associated cancer risk. Endoscopists were evenly split on the effects of leaving such polyps unresected, with about 50 % thinking that leaving diminutive polyps in place would increase the cancer risk of patients.…”

“…Attitudes of endoscopists and patients with regards to a resect-and-discard strategy When Willems et al asked endoscopists in their worldwide survey about barriers to implementation of a resect-and-discard strategy, it appears the clinical uptake of resect-and-discard is low [34]. They found that only 15.8 % of the endoscopists used the resect-and-discard strategy in their current practice and 59.9 % thought that implementation of the resect-and-discard strategy was not feasible in its current form.…”

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

“…Although the concept of resect-and-discard presents a great potential to improve colonoscopy practice, its widespread clinical implementation has not been achieved. A recent survey revealed that endoscopists have failed to adopt the use of the resect-and-discard strategy in clinical practice because of concerns about making the wrong diagnosis and subsequently an erroneous surveillance interval assignment, with its potential medicolegal repercussions [13].…”

Artificial intelligence-assisted colonoscopy: A review of current state of practice and research

“…Optical diagnosis can distinguish between neoplastic and non-neoplastic polyps and therefore deliver clinical and cost benefits by reducing the number of unnecessary histopathology examinations and providing immediate surveillance interval recommendations to patients. However, despite the demonstrated high accuracy of optical diagnosis for diminutive polyps, endoscopists have been reluctant to support its broad implementation because of concerns about incorrect diagnoses, assignment of inappropriate surveillance intervals, and related medicolegal issues[ 16 ].…”