Endoscopy 2019; 51(04): S92
DOI: 10.1055/s-0039-1681442
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: Colonic polyps: characterization Club D
Georg Thieme Verlag KG Stuttgart · New York

THE POLYP-BASED RESECT-AND-DISCARD STRATEGY

A Duong
1   University of Montreal, Faculty of Medicine, Montreal, Canada
2   University of Montreal Hospital Research Center, Montreal, Canada
,
M Bouin
2   University of Montreal Hospital Research Center, Montreal, Canada
3   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, Canada
,
E Deslandres
2   University of Montreal Hospital Research Center, Montreal, Canada
3   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, Canada
,
R Leduc
2   University of Montreal Hospital Research Center, Montreal, Canada
3   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, Canada
,
A Deshêtres
2   University of Montreal Hospital Research Center, Montreal, Canada
4   University of Montreal, Divion of Internal Medicine, Montreal, Canada
,
A Weber
2   University of Montreal Hospital Research Center, Montreal, Canada
3   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, Canada
,
H Pohl
5   Department of Veterans Affairs Medical Center, White River Junction, United States
6   Geisel School of Medicine and The Dartmouth Institute, Hanover, United States
,
A Barkun
7   McGill University, Gastroenterology, Montreal, Canada
,
D von Renteln
2   University of Montreal Hospital Research Center, Montreal, Canada
3   University of Montreal Hospital Center, Division of Gastroenterology, Montreal, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Current clinical practice assigns post-polypectomy surveillance intervals based on the number, size and histological aspects of polyps. Our goal was to test a novel polyp-based resect and discard model that assigns surveillance intervals for small polyps based only on size and number of polyps.

Methods:

A post-hoc analysis was performed on patients previously enrolled in a prospective colonoscopy trial. We created a model for polyp-based surveillance interval allocation based on clinical experience for what the most likely pathology-based surveillance interval would be according to certain scenarios. The primary outcome was the surveillance interval agreement of the polyp-based resect and discard strategy compared to histopathology and USMSTF based surveillance intervals. Secondary outcomes were the overall reduction in required pathology exams and the number of surveillance intervals that can be provided immediately to patients before leaving the endoscopy unit. In addition, we conducted a medical chart review to assess current clinical practice of surveillance interval guideline adherence at our institution.

Results:

457 patients (mean-age 62.7, 514 small polyps) were enrolled in the study. When using the polyp-based resect and discard model, the assigned surveillance intervals were correct for 89,3% (95% CI: 0.86 – 92) of patients when compared to pathology-based surveillance interval assignment. When using the polyp-based model, 88,8% of patients can be provided with immediate surveillance interval recommendations compared to 47,7% when using the pathology-based surveillance interval allocation. When using the polyp-based model, 61.4% of pathology examinations can be omitted. Medical chart review showed that at our institution 43.8% of patients received surveillance interval recommendations.

Conclusions:

The polyp-based resect-and-discard strategy reaches an almost 90% agreement compared to pathology-based surveillance interval allocation. This alternative method largely reduces the need for pathology exams, increases the amount of patients that can be provided with immediate surveillance interval recommendations at the time of index colonoscopy and can increase guideline-conform surveillance intervals.