Aims:
To better understand endoscopists opinion regarding cancer risk of diminutive polyps, current use and barriers for implementation of the resect-and-discard strategy and preferred polypectomy approches.
Methods:
A survey using Google form was distributed through national and international endoscopy, gastroenterology and surgical societies. Study domains included demographics and practice characteristics, perception of cancer risk for diminutive polyps, uptake and barriers to the resect-and-discard strategy, preferred polypectomy techniques for 1 – 20 mm polyps and uptake of novel techniques, such as cold snare polypectomy.
Results:
808 endoscopists participated in the survey. 48.4% (95% CI 45.0%-51.9%) of endoscopists believe that leaving diminutive polyps in place is associated with an increased cancer risk and 54.7% (95% CI 53.6%-60.4%) believe that doing so within current CT-colonography screening increases patient's risk of cancer. 80.3% (95% CI 77.5%-83.0%) of endoscopists believe that using the resect-and-discard strategy for diminutive polyps will not increase cancer risk. However, 84.2% (95% CI 81.6%-86.7%) of endoscopists are presently not using this strategy and 59.9% (95% CI 56.5%-63.2%) do not believe it is feasible for use in general practice. Main barriers to implement were: being afraid of making a wrong diagnosis (44.6%), concerns of potential medico-legal issues (53.8%) and being afraid of giving wrong surveillance intervals (58.3h). 87.5% (95% CI 85.2%-89.8%) of respondents reported an increased use of cold snare polypectomy in the past 5 years. Cold snare polypectomy is the most frequently applied polypectomy technique for 4 to 5 mm and 6 to 10 mm polyps (67.0% (95% CI (63.7%-70.2%) and 55.2% (95% CI 51.8%-58.6%) respectively).
Conclusions:
Half of endoscopists think that leaving diminutive polyp might increase the risk of cancer. The majority do not used the resect-and-discard strategy and think it is not feasible for clinical implementation. Cold snare polypectomy has become the preferred polypectomy technique for 4 to 10 mm polyps.
