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
ARTICLE HIGHLIGHTS
Research background

The majority (90%) of polyps found during colonoscopies are less than 10 mm in size, with diminutive polyps (< 5 mm) accounting for about 70%–80%. Advanced histology is found in only 1.7% of diminutive polyps and 10.1% of small polyps. Current post-polypectomy surveillance intervals are based on pathology outcomes. However, histopathologic evaluation of small polyps can incur significant costs.

Research motivation

Alternative modalities have been proposed, such as image-enhanced endoscopy-assisted optical polyp diagnosis. Limitations of the optical diagnosis included fear of making an incorrect optical diagnosis, assigning incorrect surveillance intervals, and training requirements.

Research objectives

We aimed to develop a novel resect and discard model that did not require optical diagnosis to assign colonoscopy surveillance intervals, and assigned surveillance interval based on number and size of polyps, so-called the polyp-based resect and discard (PBRD) strategy.

Research methods

In a clinical prospective study, all patients undergoing elective colonoscopies were enrolled. 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 and the pathology-based reference standard using the 2020 United States Multi-Society Task Force guidelines.

Research results

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.

Research conclusions

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.

Research perspectives

Future research should assess PBRD in multicentered studies and community-based practices.