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A "resect and discard" strategy with risk-stratified management based on polyp diameter, number, and resection
Min Huang1, Lu Sun2, Yaping Weng1
1Department of Gastroenterology, Hangzhou Ninth Hospital (Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine Qiantang Campus), No. 98 Yilong Road, Yipeng Street, Qiantang District, Hangzhou City, Zhejiang Province, China.
Background:
Current "resect and discard" strategies, which rely on advanced optical diagnosis or artificial intelligence, face challenges in widespread adoption because of high technological and equipment requirements.
Methods:
We retrospectively analyzed data from patients who underwent complete endoscopic resection of colorectal polyps with a definitive pathological diagnosis at Hangzhou Ninth Hospital between May 2015 and July 2025. Different "resect and discard" strategies and recommended endoscopic follow-up intervals were formulated based on polyp diameter and number. The concordance between the follow-up intervals suggested by our strategy and those recommended by current pathology-based guidelines was analyzed. This strategy was further validated in patients who underwent follow-up after their initial polypectomy.
Results:
A total of 7,265 patients (mean age 56.34 years, 63.0% male) with 10,004 polyps were included in the study. Polyps ≤ 5 mm constituted the greatest proportion (86.4%), while the incidence of high-risk polyps was low (0.35%). The "resect and discard" strategy applied to patients with 1-2 polyps ≤ 5 mm demonstrated high applicability (80.11%) and excellent agreement with guideline-recommended surveillance intervals (99.59%; 95% CI: 0.994-0.997). A significant difference was observed in the proportion of high-risk polyps among resected 6-9 mm polyps between patients who underwent their first polypectomy and those in the surveillance phase (22.41% vs. 3.45%, P < 0.001). For surveillance patients with 1-2 polyps < 10 mm, the concordance of the "resect and discard" strategy with the guidelines improved by approximately 99.48% (95% CI: 0.989-1.000).
Conclusion:
In patients with 1-2 polyps ≤ 5 mm, the "resect and discard" strategy demonstrates both excellent feasibility and safety, and the follow-up period is 99.59% consistent with the guidelines. Furthermore, the scope of this strategy can be safely expanded for patients undergoing polypectomy during postresection surveillance.
