Resect and discard strategy in clinical practice: a prospective cohort study

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Narrow-band imaging (NBI) shows promise in differentiating adenomatous from non-adenomatous colonic polyps.
• A "resect and discard" strategy using NBI could enable surveillance intervals to be set without histopathology for small polyps (<10 mm).

Purpose of the Study:

• To evaluate the feasibility and safety of the NBI-assisted "resect and discard" strategy in routine clinical practice for small colonic polyps.

Main Methods:

• Prospective inclusion of consecutive colonoscopy outpatients with small polyps (<10 mm).
• Endoscopic categorization of polyps as adenoma or non-adenoma using simplified NBI criteria.
• Assignment of post-polypectomy surveillance intervals based on NBI findings, with subsequent comparison to histology-based intervals.

Main Results:

• NBI demonstrated high sensitivity (94.9%) and accuracy (85.7%) for in vivo adenoma diagnosis.
• The NBI-directed surveillance strategy aligned with the histology-directed strategy in 82.9% of patients.
• The strategy could lead to early or delayed surveillance in 9.8% and 7.3% of patients, respectively.

Conclusions:

• The "resect and discard" strategy is a viable, safe, and cost-effective approach for managing patients with small colonic polyps.
• Caution is advised for polyps 6-9 mm and right-sided lesions due to their malignant potential.
• The study was registered on Clinicaltrials.gov (NCT01462123).