Benign Polyps of Large Intestine
Conditions
Keywords
colorectal polyps, resect and discard, endoscopic prediction, histological diagnosis, narrow band imaging
Brief summary
Resect and discard (RD) is a new paradigm for management of diminutive colorectal polyps wherein histology is determined by real-time endoscopic imaging; polyps are then resected and discarded rather than sent for histopathological review. The aims of this study were to compare the surveillance recommendations between RD and the standard of care where polyps are sent for histopathological review in a mixed setting of academic and community gastroenterologists and to evaluate the diagnostic performance of an RD program for management of diminutive polyps.
Detailed description
Introduction: Diminutive (≤5 mm) colorectal polyps are prevalent in the screening population but have low risk for harboring advanced villous or dysplastic components and for developing into colorectal cancer. Resect and discard (RD) is a new paradigm for management of these diminutive polyps wherein histology is determined by real-time endoscopic imaging; polyps are then resected and discarded rather than sent for histopathological review. Aim: The aim of this study were to compare the surveillance recommendations between RD and the standard of care where polyps are sent for histopathological review in a mixed setting of academic and community gastroenterologists and to evaluate the diagnostic performance of an RD program for management of diminutive polyps. Methods: This is a prospective, observational study conducted in a single outpatient endoscopy center over 12 months. Screening and surveillance colonoscopies were performed by four academic and two community gastroenterologists. All diminutive polyps (defined as ≤5 mm) were endoscopically imaged and histology predictions (adenoma vs. non-adenomatous polyp) were made using high-definition white light (HDWL) with/without narrow band imaging (NBI) at the discretion of the endoscopist. Diagnostic performance and accordance of recommended surveillance intervals from endoscopic imaging were compared to histopathological review of the polyps.
Interventions
PROCEDUREColonoscopy
The location, size, and morphology of all lesions detected during colonoscopy were recorded. The size of each identified polyp was visually estimated . All diminutive polyps (defined as ≤5 mm) were endoscopically imaged and histology predictions (adenoma vs. non-adenomatous polyp) were made using HDWL with/without NBI at the discretion of the endoscopist.
Sponsors
Washington University School of Medicine
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients were included if diminutive polyps (defined as ≤5 mm) were identified at colonoscopy.
Exclusion criteria
* indication other than screening or surveillance * no diminutive polyps were found * an optical or histopathological diagnosis of the diminutive polyp could not be made * the polyp was resected but not retrieved for histopathology * a synchronous colorectal cancer was identified at the time of the colonoscopy * polyposis syndrome * inflammatory bowel disease * colonoscopies not complete to cecum * fair or poor bowel preparation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| concordance of recommended surveillance intervals | 30 days | concordance of recommended surveillance intervals based on endoscopic optical diagnosis compared to histopathological diagnosis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| diagnostic performance | 30 days | Diagnostic performance \[accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)\] of adenomatous and non-adenomatous polyps by optical diagnosis using HDWL with/without NBI Subgroup analyses were also planned to evaluate diagnostic performance by level of confidence in prediction, type of endoscopist (academic vs. community), and use of NBI. |
Countries
United States
Outcome results
None listed