Resect and Discard Strategy in Clinical Practice

Valduce Hospital286 enrolled

Overview

Nowadays, post-polypectomy surveillance intervals are determined by combining endoscopic and pathologic data. Real-time imaging technologies, have shown promising results in discriminating adenomatous from non-adenomatous polyps. The "resect and discard strategy" for small polyps (based on real-time assessment of the histology and on the endoscopic resection without pathological examination) has been shown to be cost-effective in simulation models. No data exist about the impact of this strategy in clinical practice. The aim of present study was to assess whether the systematic use, in the everyday clinical practice, of the "resect and discard strategy" allows to correctly manage patients with small colonic polyps.

Study Type

OBSERVATIONAL

Enrollment

286

Conditions

Endoscopic Assessment Colonic Polyps Endoscopic Surveillance NBI

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * consecutive adult outpatients undergoing colonoscopy for routine clinical indications Exclusion Criteria: * surveillance interval was not necessarily directed by endoscopic findings (history of colorectal cancer, inflammatory bowel disease, hereditary polyposis syndromes, hereditary non-polyposis colorectal cancer) * colonoscopy was performed without NBI technology * at least one lesion \> 10 mm or \< 10 mm but with morphologic features suspect for malignancy (depressed or ulcerated lesions) was detected * bowel preparation was inadequate * caecal intubation was not accomplished * polyps could not be resected for concomitant anticoagulation treatment, 7) polyps were resected but not retrieved for pathology.

Outcomes

Primary Outcomes

The primary outcome of the study was to assess the agreement between "endoscopy-" and "histology-determined" surveillance strategies after small adenoma resection.

Secondary Outcomes

sensitivity of the endoscopic assessment (WL coupled with NBI) of small (<10 mm) adenomas

operative characteristics for the diagnosis of diminutive (< 5 mm) adenomas

the feasibility of non histologic evaluation, represented by the proportion of polyps in which a in-vivo diagnosis of adenoma can be made with high confidence

specificity of the endoscopic assessment

accuracy of the endoscopic assessment