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The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study.
Taghiakbari, Mahsa; Pohl, Heiko; Djinbachian, Roupen; Barkun, Alan; Marques, Paola; Bouin, Mickael; Deslandres, Eric; Panzini, Benoit; Bouchard, Simon; Weber, Audrey; von Renteln, Daniel.
Afiliación
  • Taghiakbari M; University of Montréal, Montréal, Quebec, Canada.
  • Pohl H; University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.
  • Djinbachian R; Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA.
  • Barkun A; Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, USA.
  • Marques P; University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.
  • Bouin M; Division of Internal Medicine, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada.
  • Deslandres E; Division of Gastroenterology, McGill University Health Center, McGill University, Montréal, Quebec, Canada.
  • Panzini B; Faculty of Medicine, Bahia State University, Salvador, Bahia, Brazil.
  • Bouchard S; University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.
  • Weber A; Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada.
  • von Renteln D; Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada.
Endoscopy ; 54(4): 354-363, 2022 04.
Article en En | MEDLINE | ID: mdl-34448185
BACKGROUND: Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent. METHODS: The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment. RESULTS: 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96-0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67-0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52-0.58; NICE and Sano) and 41.9 % (95 %CI 0.39-0.45; WASP) with optical diagnosis. CONCLUSION: The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Pólipos del Colon Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Endoscopy Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Colorrectales / Pólipos del Colon Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Endoscopy Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Alemania