Patient Acceptability of Optical Diagnosis for Diminutive Polyps With a Resect And Discard Strategy In Bowel Cancer Screening Colonoscopy

Aims Colonoscopy with polypectomy reduces the rate of subsequent colorectal cancer and associated mortality. Most polyps resected are diminutive and with a low cancer risk. Currently, these diminutive polyps are resected and examined histologically. Using advanced imaging technologies some studies show we can distinguish adenomas from non-adenomas optically. This could potentially avoid unnecessary polypectomies and associated histology costs in cases where there is high confidence in the diagnosis of the polyps allowing polyps to be resected and discarded. The aim of this study is to assess the acceptability of such a strategy for patients in real life clinical practice.

Methods Two hundred and fifty patients undergoing a bowel cancer screening colonoscopy procedure, where optical diagnosis was used as part of the DISCARD3 study, were invited to participate in a patient experience survey. This was carried out over February - October 2020 at a London bowel cancer screening centre (screening population 1.1 million) with 209 patients included (41 patients excluded: 33 did not complete, 8 did not consent).Patients were asked to rate the questions in the table below:

Questionnaire

Response options

My colonoscopy was comfortable. I would be happy for any polyps found during my colonoscopy to be assessed by the person carrying out the procedure at the time (rather than to wait for laboratory results to get the diagnosis). If a future colonoscopy is advised I would prefer to be informed immediately after the initial procedure rather than wait to be told later by telephone or in the outpatient department. I feel confident that the person carrying out the procedure could accurately diagnose polyps without sending them to the laboratory. I felt highly satisfied with the procedure today. If you have had a previous colonoscopy, did you notice any difference in the procedure today compared with previously?

Questions 1-5: 5 point scale from strongly disagree to strongly agree. Question 6: Yes, No or N/A.

Results Most patients found their procedure comfortable (85.2 %; 178/209) and were satisfied with their procedure (97.6 %; 204/209). Most agreed or strongly agreed that they would be happy for polyps to be assessed optically (78.9 %; 165/209) and felt confident in the ability of the endoscopist to do this (90.9 %; 190/209). 85.2 % (178/209) would be happy to be informed of their colonoscopy surveillance interval immediately after the procedure.

Conclusions In this small but representative sample, optical diagnosis of diminutive polyps using a resect and discard strategy appears to be an acceptable approach for patients within a bowel cancer screening programme . To achieve similar levels of acceptability in standard clinical practice patients may require additional and enhanced information about the concept and application of a resect and discard strategy.

Citation: Ahmad A, Wilson A, Thomas-Gibson S et al. eP176 PATIENT ACCEPTABILITY OF OPTICAL DIAGNOSIS FOR DIMINUTIVE POLYPS WITH A RESECT AND DISCARD STRATEGY IN BOWEL CANCER SCREENING COLONOSCOPY. Endoscopy 2021; 53: S154.