Clinical outcomes of the “resect and discard” strategy using magnifying narrow-band imaging for small (< 10 mm) colorectal polyps

Abstract

Background and study aim The “resect and discard” strategy is a new paradigm for the management of small colorectal polyps that reduces the cost and effort related to pathological diagnosis after polypectomy. This retrospective study aimed to clarify the clinical outcome of the “resect and discard” strategy for small colorectal polyps.

Patients and methods The clinical records were reviewed from 501 consecutive patients who underwent the “resect and discard” strategy for colorectal polyps smaller than 10 mm at our hospital between January 2008 and December 2010. All colorectal lesions were evaluated onsite under magnifying narrow-band imaging after careful conventional white-light imaging. In cases of low grade adenoma predicted with high confidence, colonoscopists selected the “resect and discard” option without formal histopathology. The mid-term outcomes were evaluated to validate the curability of the “resect and discard” strategy.

Results The present study included 501 consecutive patients with 816 lesions. The mid-term outcomes were examined for 476 (95 %) patients who received follow-up for at least 1 year after undergoing the “resect and discard” strategy. The median observation period was 83 months (range 12 – 117 months). No patient died from colorectal cancer related to the procedure, resulting in a disease-specific survival rate of 100 %. There were no local and/or distant recurrences detected during follow-up.

Conclusions The “resect and discard” strategy for small colorectal polyps under strict preoperative diagnosis achieves excellent mid-term outcome.

• References

• 1 Leung WK, Lo OS, Liu KS. et al. Detection of colorectal adenoma by narrow band imaging (HQ190) vs. high-definition white light colonoscopy: a randomized controlled trial. Am J Gastroenterol 2014; 109: 855-863
• 2 Morison B. President’s address: The polyp-cancer sequence in the large bowel. Proc R Soc Med 1974; 67: 451-457
• 3 Winawer SJ, Zauber AG, Ho MN. et al. The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy. NEJM 1993; 329: 1977-1981
• 4 Ignjatovic A, East JE, Suzuki N. et al. Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 2009; 10: 1171-1178
• 5 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 6 Patel SG, Schoenfeld P, Kim HM. et al. Real-time characterization of diminutive colorectal polyp histology using narrow-band imaging: implications for the resect and discard strategy. Gastroenterology 2016; 150: 406-418
• 7 Gupta N, Bansal A, Rao D. et al. Accuracy of in vivo optical diagnosis of colon polyp histology by narrow-band imaging in predicting colonoscopy surveillance intervals. Gastrointest Endosc 2012; 75: 494-502
• 8 Oka S, Tanaka S, Nakadoi K. et al. Endoscopic features and management of diminutive colorectal submucosal invasive carcinoma. Dig Endosc 2014; 26 (Suppl. 02) 78-83
• 9 Machida H, Sano Y, Hamamoto Y. et al. Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 2004; 36: 1094-1098
• 10 Katagiri A, Fu KI, Sano Y. et al. Narrow-band imaging with magnifying colonoscopy as diagnostic tool for predicting histology of early colorectal neoplasia. Aliment Pharmacol Ther 2008; 27: 1269-1274
• 11 Takeuchi Y, Hanafusa M, Kanzaki H. et al. Proposal of a new ‘resect and discard’ strategy using magnifying narrow-band imaging: pilot study of diagnostic accuracy. Dig Endosc 2014; 26 (Suppl. 02) 90-97
• 12 Takeuchi Y, Hanafusa M, Kanzaki H. et al. An alternative option for “resect and discard” strategy, using magnifying narrow-band imaging: a prospective “proof-of-principle” study. J Gastroenterol 2015; 50: 1017-1026
• 13 Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon – November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-43
• 14 Uraoka T, Saito Y, Ikematsu H. et al. Sano’s capillary classification for narrow band imaging of early colorectal lesions. Dig Endosc 2011; 23 (Suppl. 01) 112-115
• 15 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels using narrow band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69: 278-283
• 16 Morris EJ, Rutter MD, Finan PJ. et al. Post-colonoscopy colorectal cancer (PCCRC) rates vary considerably depending on the method used to calculate them: a retrospective observational population-based study of PCCRC in the English National Health Service. Gut 2015; 64: 1248-1256
• 17 Singh S, Singh PP, Murad MH. et al. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 2014; 109: 1375-1389
• 18 Kanda Y. Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant 2013; 48: 452-458
• 19 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
• 20 Sumimoto K, Tanaka S, Shigita K. et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc 2017; 85: 816-821
• 21 Rex DK, Kahi C, O’Brien M. et al. The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2011; 73: 419-422
• 22 Abu Dayyeh BK, Thosani N. et al. ASGE Technology Committee. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 2015; 81: 502.e1-502.e16
• 23 Shima H, Tanaka S, Kuwai T. et al. Minute depressed colon cancer with submucosal invasion. Gastrointest Endosc 2003; 57: 564-565
• 24 Takeuchi Y, Uedo N, Higashino K. et al. Autofluorescence imaging of a diminutive, depressed-type early colon cancer invaded to the submucosal layer. Gastrointest Endosc 2010; 71: 399-400
• 25 Hotta K, Imai K, Yamaguchi Y. et al. Diminutive submucosally invasive cancers of the colon and rectum. Endoscopy 2015; 47 (Suppl. 01) E2-3
• 26 Ikematsu H, Matsuda T, Emura F. et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 2010; 10: 33
• 27 Zauber AG, Winawer SJ, O’Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. NEJM 2012; 366: 687-696
• 28 Hassan C, Pickhardt PJ, Rex DK. A resect and discard strategy would improve cost effectiveness of colorectal cancer screening. Clin Gastroenterol Hepatol 2010; 8: 865-869
• 29 Kessler WR, Imperiale TF, Klein RW. et al. A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps. Endoscopy 2011; 43: 683-691
• 30 Tanaka S, Saitoh Y, Matsuda T. et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2015; 50: 252-260
• 31 Maeda Y, Kudo SE, Wakamura K. et al. The concept of ‘Semi-clean colon’ using the pit pattern classification system has the potential to be acceptable in combination with a <3-year surveillance colonoscopy. Oncol Lett 2017; 14: 2735-2742
• 32 Ninomiya Y, Oka S, Tanaka S. et al. Clinical impact of surveillance colonoscopy using magnification without diminutive polyp removal. Dig Endosc 2017; 29: 773-781
• 33 Matsuda T, Fujii T, Sano Y. et al. Five-year incidence of advanced neoplasia after initial colonoscopy in Japan: a multicenter retrospective cohort study. Jpn J Clin Oncol 2009; 39: 435-442
• 34 Sano Y, Fujii T, Oda Y. et al. A multicenter randomized controlled trial designed to evaluate follow-up surveillance strategies for colorectal cancer: the Japan Polyp Study. Dig Endosc 2004; 16: 376-378
• 35 Matsuda T, Chiu H-M, Sano Y. et al. Surveillance colonoscopy after endoscopic treatment for colorectal neoplasia: from the standpoint of the Asia–Pacific region. Dig Endosc 2016; 28: 342-347