Trial Information

"Resect and Discard" Approach to Diminutive Colonic Polyps: Real World Applicability Amongst Both Academic and Community Gastroenterologists

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.