Published online May 21, 2022. doi: 10.3748/wjg.v28.i19.2137
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
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.
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.
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.
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.
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.
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.
Future research should assess PBRD in multicentered studies and community-based practices.