Standard colonoscopy practice requires removal and histological characterization of almost all small (<10 mm) and diminutive (≤5 mm) colorectal polyps found. The aim of this study was to test a simplified polyp-based resect and discard (PBRD) strategy that assigns surveillance intervals based only on size and number of small and diminutive polyps, without the need for pathology.
A post hoc analysis was performed on patients enrolled in a prospective colonoscopy study. The primary outcome was surveillance interval agreement of the PBRD strategy compared with pathology-based management according to the 2020 USMSTF guidelines. A chart analysis also evaluated clinician adherence to the pathology-based recommendations for included patients. One-sided testing was performed with a null-hypothesis of 90% agreement with pathology-based surveillance intervals and a two-sided 96.7% CI using correction for multiple testing.
452 patients were included in the study. Surveillance intervals assigned using the PBRD strategy were correct in 97.8% (96.7% CI [96.3% ; 99.3%]) of patients when comparing to pathology-based management. The PBRD strategy reduced pathological examinations by 58.7% while providing 87.8% of patients immediate surveillance interval recommendation on the day of the colonoscopy compared with 47.1% when using pathology-based management. Chart analysis of surveillance interval assignments showed 63.3% adherence to the pathology-based guideline.
The PBRD strategy surpassed the 90% agreement with the pathology-based standard for determining subsequent colonoscopy surveillance interval. Furthermore, it reduced the need for pathological examinations and increased the proportion of patients receiving correct surveillance interval recommendations issued on the day of the colonoscopy. The PBRD strategy does not require any expertise in optical diagnosis and may replace any histological characterization of small and diminutive colorectal polyps.