Abstract
BackgroundDistal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement.MethodsIn this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed.ResultsThe overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy.ConclusionsHigh-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps.Trial registrationClinicalTrials NCT02217449.
Highlights
Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection
The median size of the polyps was 3 mm and all polyps studied were diminutive, thereby ≤ 5 mm in size. 63 polyps were nonadenomatous, of which almost all were hyperplastic by histology (62 out of 63) while 1 polyp was a leiomyoma. 47 % of all polyps showed adenomatous histology (57 out of 121)
Here, we have shown that digital chromoendoscopy can reliable predict histology of distal diminutive polyps in real time according to the recommendations of the American Society for Gastrointestinal Endoscopy (ASGE) Preservation and incorporation of valuable endoscopic innovations (PIVI) statement
Summary
Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. Distal diminutive polyps (polyps ≤ 5 mm) are frequently observed in daily clinical routine and can be found in more than 50 % of the screening population [1, 2]. One paradigm describes endoscopic resection of colorectal polyps without submitting them for pathological assessment (“resect and discard”) while the other paradigm describes to leave diminutive hyperplastic rectosigmoid polyps in place without resection [8]. A prerequisite for both approaches is that an accurate real-time endoscopic assessment of the colorectal polyp histology could be made [8]
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