Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2022; 28(19): 2137-2147
Published online May 21, 2022. doi: 10.3748/wjg.v28.i19.2137
Non-optical polyp-based resect and discard strategy: A prospective clinical study
Mahsa Taghiakbari, Celia Hammar, Mira Frenn, Roupen Djinbachian, Heiko Pohl, Erik Deslandres, Simon Bouchard, Mickael Bouin, Daniel von Renteln
Mahsa Taghiakbari, Celia Hammar, Mira Frenn, Roupen Djinbachian, Erik Deslandres, Simon Bouchard, Mickael Bouin, Daniel von Renteln, Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
Celia Hammar, Mira Frenn, Department of Gastroenterology, University of Montreal, Faculty of Medicine, Montreal H2X 0A9, Quebce, Canada
Roupen Djinbachian, Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal H2X 0A9, Quebec, Canada
Heiko Pohl, Department of Medicine, Veterans Affairs Medical Center, White River Junction, VT 05009, United States
Heiko Pohl, Department of Gastroenterology, Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, NH 03755, United States
Author contributions: Taghiakbari M contributed to analysis and interpretation of data, drafting the manuscript under the supervision of von Renteln D; Hammar C and Frenn M performed the acquisition of data; Hammar C, Frenn M and von Renteln D contributed to analysis and interpretation of data, drafting of the manuscript; Frenn M, Djinbachian R, Pohl H and von Renteln D contributed to the study concept and design, critical revision of the manuscript for important intellectual content; Deslandres E, Bouchard S and Bouin M contributed to the critical revision of the manuscript for important intellectual content.
Institutional review board statement: The study protocol and data collection were approved by the local institutional research board as an amendment to the two prospective clinical studies (17.135 and 16.367, respectively).
Clinical trial registration statement: This study is registered at the Protocol Registration and Results System.
Conflict-of-interest statement: Mahsa Taghiakbari, Celia Hammar, Mira Frenn, Roupen Djinbachian, Heiko Pohl, Erik Deslandres, Simon Bouchard, and Mickael Bouin have no conflicts of interest relevant to this paper to disclose. 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.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mahsa.taghiakbari@umontreal.ca. Participants gave informed consent for data sharing. No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mahsa Taghiakbari, MD, Research Scientist, Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), 900 Rue Saint-Denis, Montréal H2X 0A9, Quebec, Canada. mahtakbar@gmail.com
Received: January 2, 2022
Peer-review started: January 2, 2022
First decision: March 10, 2022
Revised: March 21, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: May 21, 2022
Processing time: 134 Days and 19.5 Hours
Abstract
BACKGROUND

Post-polypectomy surveillance intervals are currently determined based on pathology results.

AIM

To evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and size.

METHODS

Patients undergoing elective colonoscopies at the Montreal University Medical Center were enrolled prospectively. The polyp-based strategy was used to assign the next surveillance interval using polyp size and number. Surveillance intervals were also assigned using optical diagnosis for small polyps (< 10 mm). The primary outcome was surveillance interval agreement between the polyp-based model, optical diagnosis, and the pathology-based reference standard using the 2020 United States Multi-Society Task Force guidelines. Secondary outcomes included the proportion of reduction in required histopathology evaluations and proportion of immediate post-colonoscopy recommendations provided to patients.

RESULTS

Of 944 patients (mean age 62.6 years, 49.3% male, 933 polyps) were enrolled. The surveillance interval agreement for the polyp-based strategy was 98.0% [95% confidence interval (CI): 0.97–0.99] compared with pathology-based assignment. Optical diagnosis-based intervals achieved 95.8% (95%CI: 0.94–0.97) agreement with pathology. When using the polyp-based strategy and optical diagnosis, the need for pathology assessment was reduced by 87.8% and 70.6%, respectively. The polyp-based strategy provided 93.7% of patients with immediate surveillance interval recommendations vs 76.1% for optical diagnosis.

CONCLUSION

The polyp-based strategy achieved almost perfect surveillance interval agreement compared with pathology-based assignments, significantly reduced the number of required pathology evaluations, and provided most patients with immediate surveillance interval recommendations.

Keywords: Colonoscopy; Colorectal pathology; Colorectal adenomas; Endoscopy; Surveillance; Optical diagnosis

Core Tip: Background current post-polypectomy surveillance intervals are based on pathology outcomes. Our aim was to test a novel polyp-based resect and discard model that assigns surveillance interval based on number and size of polyps. Findings Surveillance interval based on a polyp-based strategy achieved 98.0% (95% confidence interval: 0.97–0.99) agreement with pathology-based intervals when applied according to the current surveillance guideline. Implications for patient care the polyp-based strategy can easily be implemented without any requirement for specialist devices and training. The majority of patients can be provided with immediate surveillance interval recommendations, without having to wait for results of pathology analysis.