Resect and discard: Is it ready or time to shift gear?

Numerous colonoscopies are performed in Europe, either within organized colorectal cancer screening programs based on fecal immunochemical testing (FIT) or as primary screening procedures. In this process, accidental diminutive polyps are found that do not explain the positive FIT test and that may not significantly affect the cancer risk for that individual [1].

Publication History

Article published online:
16 June 2020

• References

• 1 Lieberman D, Moravec M, Holub J. et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135: 1100-1105
• 2 Hassan C, Quintero E, Dumonceau J-M. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-864
• 3 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
• 4 Bisschops R, East JE, Hassan C. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 1155-1179
• 5 Ijspeert JEG, Bastiaansen BAJ, van Leerdam ME. et al. Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut 2016; 65: 963-970
• 6 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607.e1
• 7 Bisschops R, Hassan C, Bhandari P. et al. BASIC (BLI Adenoma Serrated International Classification) classification for colorectal polyp characterization with blue light imaging. Endoscopy 2018; 50: 211-220
• 8 Hassan C, Bisschops R, Bhandari P. et al. Predictive rules for optical diagnosis of  10-mm colorectal polyps based on a dedicated software. Endoscopy 2020; 52: 52-60
• 9 Iacucci M, Trovato C, Daperno M. et al. Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps. Endoscopy 2018; 50: 779-789
• 10 Rees CJ, Rajasekhar PT, Wilson A. et al. Narrow band imaging optical diagnosis of small colorectal polyps in routine clinical practice: the Detect Inspect Characterise Resect and Discard 2 (DISCARD 2) study. Gut 2017; 66: 887-895
• 11 van de Wetering AJP, Meulen LWT, Bogie RMM. et al. Optical diagnosis of diminutive polyps in the Dutch Bowel Cancer Screening Program: Are we ready to start?. Endosc Int Open 2020; 08: E257-E265
• 12 Open EI. Uptake and barriers for implementation of the resect and discard strategy. 2020; 08: E684-E692
• 13 Rex DK, Patel NJ, Vemulapalli KC. A survey of patient acceptance of Resect and Discard for diminutive polyps. Gastrointest Endosc 2015; 82: 376-380.e1
• 14 Bisschops R, Dekker E, East JE. et al. European Society of Gastrointestinal Endoscopy (ESGE) curricula development for postgraduate training in advanced endoscopic procedures: rationale and methodology. Endoscopy 2019; 51: 976-979
• 15 Esteva A, Kuprel B, Novoa RA. et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature 2017; 542: 115-118
• 16 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
• 17 Bernal J, Tajkbaksh N, Sanchez FJ. et al. Comparative validation of polyp detection methods in video colonoscopy: Results From the MICCAI 2015 Endoscopic Vision Challenge. IEEE Trans Med Imaging 2017; 36: 1231-1249
• 18 Chen P-J, Lin M-C, Lai M-J. et al. Accurate classification of diminutive colorectal polyps using computer-aided analysis. Gastroenterology 2018; 154: 568-575
• 19 Urban G, Tripathi P, Alkayali T. et al. Deep learning localizes and identifies polyps in real time with 96% accuracy in screening colonoscopy. Gastroenterology 2018; 155: 1069-1078.e8
• 20 Kamiński MF, Hassan C, Bisschops R. et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2014; 46: 435-449
• 21 Byrne MF, Chapados N, Soudan F. et al. Real-time differentiation of adenomatous and hyperplastic diminutive colorectal polyps during analysis of unaltered videos of standard colonoscopy using a deep learning model. Gut 2019; 68: 94-100
• 22 Kudo S-E, Misawa M, Mori Y. et al. Artificial intelligence-assisted system improves endoscopic identification of colorectal neoplasms. Clin Gastroenterol Hepatol; 2020 (In press) https://linkinghub.elsevier.com/retrieve/pii/S1542356519309978