Non-optical polyp-based resect and discard strategy:A prospective clinical study

BACKGROUND Post-polypectomy surveillance intervals are currently determined based on pathology results.AIM To evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and size.METHODS Patients undergoing elective colonoscopies at the Montreal University Medical Center were enrolled prospectively.The polyp-based strategy was used to assign the next surveillance interval using polyp size and number.Surveillance intervals were also assigned using optical diagnosis for small polyps(<10 mm).The primary outcome was surveillance interval agreement between the polyp-based model,optical diagnosis,and the pathology-based reference standard using the 2020 United States Multi-Society Task Force guidelines.Secondary outcomes included the proportion of reduction in required histopathology evaluations and proportion of immediate post-colonoscopy recommendations provided to patients.RESULTS Of 944 patients(mean age 62.6 years,49.3%male,933 polyps)were enrolled.The surveillance interval agreement for the polyp-based strategy was 98.0%[95%confidence interval(CI):0.97-0.99]compared with pathology-based assignment.Optical diagnosis-based intervals achieved 95.8%(95%CI:0.94-0.97)agreement with pathology.When using the polyp-based strategy and optical diagnosis,the need for pathology assessment was reduced by 87.8%and 70.6%,respectively.The polyp-based strategy provided 93.7%of patients with immediate surveillance interval recommendations vs 76.1%for optical diagnosis.CONCLUSION The polyp-based strategy achieved almost perfect surveillance interval agreement compared with pathology-based assignments,significantly reduced the number of required pathology evaluations,and provided most patients with immediate surveillance interval recommendations.