Discard Strategy Research Articles

A31 DYSPLASIA IN COLONIC POLYPS: PREPARING FOR A RESECT AND DISCARD STRATEGY IN CANADA

Abstract Background While diminutive colorectal polyps have a negligible cancer risk, current management involves resecting and submitting all polyps for histological assessment. This is a substantial burden and cost to the healthcare system. The European Society of Gastrointestinal Endoscopy (ESGE) has recommended a “resect-and-discard strategy” without histological evaluation as an acceptable strategy when high-confidence endoscopic characterization of colorectal polyps is achieved. However, a resect and discard strategy has not been adopted yet in Canada. Aims The objective of this study was to determine the prevalence and characteristics of polyps removed at our center based on size. Methods We retrospectively reviewed colonoscopies and pathology reports at Kingston Health Sciences Center from January to December 2020. Based on the pathology report, polyps were classified as diminutive (1-5mm), small (6-9mm) or large (ampersand:003E or = 10mm). We recorded histology and the presence of high-grade dysplasia (HGD) or cancer. Results Out of 2218 colonoscopies, 2945 polyps were removed. 1703 (57.8%) polyps were diminutive with only two (0.1%) having focal HGD and none having cancer. 699 (23.7%) polyps were classified as small with three (0.4%) having HGD and none having cancer. The large polyp group had 543 (18.4%) polyps, of which 87 (16%) showed HGD and 15 (2.8%) exhibited cancer. The specific histologic findings are shown in Table 1. Endoscopy reports specifically mentioned concern of dysplasia in one out of the five polyps with HGD in the diminutive and small groups. Conclusions As expected, most polyps were either diminutive or small (81.5%). Neither of these groups had cancer and only 5 had HGD. Adopting a resect and discard strategy at our center for diminutive polyps has the potential for significant cost savings with negligible risk of missing a high-risk polyp. The next steps would involve assessing optical diagnosis sensitivity and specificity for diminutive and small polyps. Histological characterization of polyps within each size range Funding Agencies None

Limitations of the Location-Based and Polyp-Based Resect and Discard Strategies

BACKGROUND AND AIMSLocation-based resect and discard (LBRD) and polyp-based resect and discard (PBRD) are 2 recently proposed strategies to minimize the cost of colonoscopy screening and surveillance. Our study applied these strategies to our colonoscopy database retrospectively to determine the applicability of these strategies in our screening and surveillance colonoscopy population. METHODSIn total, 6024 elective screening, surveillance, or diagnostic colonoscopies performed at the University of California, Irvine, were analyzed. We compared the LBRD and PBRD recommendations with longer and shorter 2020 United States Multi-Society Task Forces (USMSTF) surveillance interval recommendations. The primary outcome was the achievement of the 90% agreement threshold set by the American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable Endoscopic Innovations. RESULTSThe LBRD strategy achieved 88.0% and 71.6% concordance with the longer and shorter 2020 USMSTF recommendation guidelines, respectively. The PBRD strategy only applied to 65.4% of procedures, with the remaining procedures still requiring pathologic evaluation. Among the applicable procedures, the PBRD strategy achieved 94.2% and 38.6% concordance with the longer and shorter USMSTF recommendation guidelines, respectively. CONCLUSIONThe PBRD strategy met the 90% preservation and incorporation of valuable endoscopic innovations threshold only when using the longer USMSTF recommendations, but concordance dropped to 38.6% when using the shorter surveillance intervals, which are commonly used in the United States. Although resect and discard may decrease reliance on pathology, these 2 strategies do not achieve the level of concordance required to replace the use of pathology for diminutive polyps in our population.

Entanglement witnessing with untrusted detectors

We consider the problem of entanglement detection in the presence of faulty, potentially malicious detectors. A common—and, as of yet, the only—approach to this problem is to perform a Bell test in order to identify nonlocality of the measured entangled state. However, there are two significant drawbacks in this approach: the requirement to exceed a critical, and often high, detection efficiency, and much lower noise tolerance. In this paper, we propose an alternative approach to this problem, which is resilient to the detection loophole and is based on the standard tool of entanglement witness. We discuss how the two main techniques to detection losses, namely the discard and assignment strategies, apply to entanglement witnessing. We demonstrate using the example of a two-qubit Bell state that the critical detection efficiency can be significantly reduced compared to the Bell test approach.

S136 Real World Validation of an Artificial Intelligence Characterization Support System for Prediction of Polyp Histology in Colonoscopy: Interim Analysis of a Prospective Multicenter Study

Introduction: Colonoscopy is the gold standard for screening of colorectal cancer. Diminutive and hyperplastic polyps do not increase a patient’s risk for colorectal cancer. Prediction of hyperplastic polyp histology is crucial for the resect and discard strategy, which saves cost and decreases procedure time in colonoscopy. This study aims to validate the performance of computer-aided diagnosis (CADx) in distinguishing between hyperplastic and neoplastic polyps during colonoscopy in a real-world setting. Methods: We conducted a prospective multicentre study comparing CADx (Fujifilm Corp., Tokyo) with endocopist optical prediction of polyp histology. We first recorded the optical diagnosis according to the NICE classification by the endoscopist. Following this, the CADx tool was switched on and its prediction recorded. Imaged polyps were resected for histological analysis, which formed the gold standard. Primary outcome was diagnostic accuracy (defined by sensitivity for diagnosis of hyperplastic polyps and concordance rate). Bowel preparation, polyp size and difficulty in location were recorded for subgroup analysis. Results: 414 patients were assessed for eligibility across 4 large tertiary institutions in Singapore between February 2021 and June 2022. 625 polyps (303 hyperplastic, 322 neoplastic) were detected in 257 patients. Concordance rates for CADx and endoscopist predictions were 74.1% [95% confidence interval (CI) 70.5%-77.5%] and 73.1% (95% CI 69.5%-76.6%%), respectively (p=NS). Sensitivity for diagnosis of hyperplastic polyps was 84.2% (95% CI 79.6%-88.1%) and 77.6% (95% CI 72.4%-82.1%) for CADx and endoscopists, respectively (p=NS). CADx also showed superior performance in predicting hyperplastic histology in diminutive polyps compared to endoscopist optical prediction using the NICE classification (sensitivity 81.7%; 95% CI 76.2%-86.4%, versus 76.3%; 95% CI 70.4%-81.5%, respectively). Diagnostic accuracy was similar when analysed according to bowel preparation and difficulty in polyp location during colonoscopy (defined as polyp location behind fold, around bend, or unable to position at 6 o’clock). Conclusion: CADx showed a trend towards increased diagnostic accuracy in prediction of hyperplastic polyp histology during colonoscopy compared to endoscopist prediction in this interim analysis. The superior performance in sensitivity for disgnosis of hyperplastic polyps was also seen in diminutive polyps, but not with poor bowel preparation and difficult polyp location.

Implementation of optical diagnosis with a “resect and discard” strategy in clinical practice: DISCARD3 study

Optical diagnosis (OD) of polyps can be performed with advanced endoscopic imaging. For high-confidence diagnoses, a "resect and discard" strategy could offer significant histopathology time and cost savings. The implementation threshold is a≥90% OD-histology surveillance interval concordance. Here we assessed the OD learning curve and feasibility of a resect and discard strategy for≤5-mm and<10-mm polyps in a bowel cancer screening setting. In this prospective feasibility study, 8 bowel cancer screening endoscopists completed a validated OD training module and performed procedures. All<10-mm consecutive polyps had white-light and narrow-band images taken and were given high- or low-confidence diagnoses until 120 high-confidence≤5-mm polyp diagnoses had been performed. All polyps had standard histology. High-confidence OD errors underwent root-cause analysis. Histology and OD-derived surveillance intervals were calculated. Of 565 invited patients, 525 patients were included. A total of 1560<10-mm polyps underwent OD and were resected and retrieved (1329≤5mm and 231 6-9mm). There were no<10-mm polyp cancers. High-confidence OD was accurate in 81.5% of≤5-mm and 92.8% of 6-9-mm polyps. Sensitivity for OD of a≤5-mm adenoma was 93.0% with a positive predictive value of 90.8%. OD-histology surveillance interval concordance for≤5-mm OD was 91.3% (209/229) for U.S. Multi-Society Task Force, 98.3% (225/229) for European Society of Gastrointestinal Endoscopy, and 98.7% (226/229) for British Society of Gastroenterology guidelines, respectively. A resect and discard strategy for high-confidence≤5-mm polyp OD in a group of bowel cancer screening colonoscopists is feasible and safe, with performance exceeding the 90% surveillance interval concordance required for implementation in clinical practice. (Clinical trial registration number: NCT04710693.).

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

BACKGROUNDPost-polypectomy surveillance intervals are currently determined based on pathology results.AIMTo evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and size. METHODSPatients 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. RESULTSOf 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.CONCLUSIONThe 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.

Soft transmission of 3D video for low power and low complexity scenario

Thanks to the rapid development of naked-eye 3D and wireless communication technology, 3D video related applications on mobile devices have attracted a lot of attention. Nevertheless, the time-varying characteristics of the wireless channel is very challenging for conventional source-channel coding based transmission strategy. Also, the high complexity of source-channel coding based transmission scheme is undesired for low power mobile terminals. An advanced transmission scheme named Softcast was proposed to achieve efficient transmission performance for 2D image/video. Unfortunately, it cannot be directly applied to wireless 3D video transmission with high efficiency. This paper proposes a more efficient soft transmission scheme for 3D video with a graceful quality adaptation within a wide range of channel Signal-to-Noise Ratio (SNR). The proposed method first extends the linear transform to 4 dimensions with additional view dimension to eliminate the view redundancy, and then metadata optimization and chunk interleaving are designed to further improve the transmission performance. Meanwhile, a synthesis distortion based chunk discard strategy is developed to improve the overall 3D video quality under the condition of limited bandwidth. The experimental results demonstrate that the proposed method significantly improves the 3D video transmission performance over the wireless channel for low power and low complexity scenarios.

Apple image fusion algorithm based on binocular acquisition system

To solve the problem that single natural scene image acquisition information in an orchard cannot meet the requirements of accurate fruit recognition and target positioning, a new apple image fusion algorithm based on the binocular acquisition system named New Non-sub-sampled Contourlet Transform algorithm is proposed to obtain a high-quality fusion image. The binocular acquisition system is constructed with the Time of Flight industrial camera and the colour camera. In order to achieve a better fusion effect, a parameter optimisation algorithm based on an Artificial Bee Colony algorithm with discard strategy for brightness saliency function is proposed to optimise the low-frequency component parameters of the new fusion coefficient rule. The experiments were taken on series of apple images under three sunlight conditions in the orchard. The experimental results show that the six evaluation indicators obtained by the new algorithm achieve the expected fusion image effect under three different types of sunlight conditions.

Increased pollution due to COVID-19 pandemic and bioremediation: A dire need of management

The purpose of this study was to provide an overview of the effects of COVID-19 on macro-plastic pollution and to consider short-term and long-term scenarios for its possible environmental and human health consequences and to discuss possible strategies to address and overcome key challenges. It was emphasized that, whether or not they are involved in a healthy health crisis, future actions should reflect the balance between public health and environmental protection, as there is no doubt that they are interrelated with bioremediation and microbial metabolism in the presence of optimal environmental conditions. Bioremediation uses natural and psychological microorganisms to break down toxic and harmful substances aerobically and anaerobically. It can be handled by a mixed microbial consortium or pure microbial strains on site (in situ) or off site (in the case of case) Phyto therapy or even natural care. Nutrients suitable for impurities, especially petroleum hydrocarbons are researched technologies for us, for this a biotechnological approach designed for bioremediation and observation. COVID 19 Pandemic pushed the world into a new challenge of waste management. In general, physicochemical technologies are used, which allow for proper ecological biomedical processes. Some bacteria are mobile, feel the contamination, and move towards it to neutralize it. This review emphasizes on current pollution, which is result of COVID 19 pandemic, as people follow use and discard strategies for different things which is a threat to our environment. Keywords: Environment, waste management, COVID 19.

Extracting Learned Discard and Knocking Strategies from a Gin Rummy Bot

Various Gin Rummy strategy guides provide heuristics for human players to improve their gameplay. Often these heuristics are either conflicting or contain ambiguity that limits their applicability, especially for discard and end-of-game decisions. This paper describes an approach to analyzing the machine learning capabilities of a Gin Rummy agent to help resolve these conflicts and ambiguities. There are three main decision points in the game: when to draw from the discard pile, which card to discard from the player's hand, and when to knock. The agent us-es a learning approach to estimate the expected utility for discards. An analysis of these utility values provides in-sight into resolving ambiguities in tips for discard decisions in human play. The agent’s end-of-game, or knocking, strategy was derived using Monte Carlo Counterfactual regret minimization (MCCFR). This approach was applied to estimate Nash equilibrium knocking strategies under different rules of the game. The analysis suggests that conflicts in the end-of-game playing tips are due in part to different rules used in common Gin Rummy variants.

Clinical validation of the SIMPLE classification for optical diagnosis of colorectal polyps

Background and study aims A novel endoscopic optical diagnosis classification system (SIMPLE) has recently been developed. This study aimed to evaluate the SIMPLE classification in a clinical cohort. Patients and methods All diminutive and small colorectal polyps found in a cohort of individuals undergoing screening, diagnostic, or surveillance colonoscopies underwent optical diagnosis using image-enhanced endoscopy (IEE) and the SIMPLE classification. The primary outcome was the agreement of surveillance intervals determined by optical diagnosis compared with pathology-based results for diminutive polyps. Secondary outcomes included the negative predictive value (NPV) for rectosigmoid adenomas, the percentage of pathology exams avoided, and the percentage of immediate surveillance interval recommendations. Analysis of optical diagnosis for polyps ≤ 10 mm was also performed. Results 399 patients (median age 62.6 years; 55.6 % female) were enrolled. For patients with at least one polyp ≤ 5 mm undergoing optical diagnosis, agreement with pathology-based surveillance intervals was 93.5 % (95 % confidence interval [CI] 91.4–95.6). The NPV for rectosigmoid adenomas was 86.7 % (95 %CI 77.5–93.2). When using optical diagnosis, pathology analysis could be avoided in 61.5 % (95 %CI 56.9–66.2) of diminutive polyps, and post-colonoscopy surveillance intervals could be given immediately to 70.9 % (95 %CI 66.5–75.4) of patients. For patients with at least one ≤ 10 mm polyp, agreement with pathology-based surveillance intervals was 92.7 % (95 %CI 89.7–95.1). NPV for rectosigmoid adenomas ≤ 10 mm was 85.1 % (95 %CI CI 76.3–91.6). Conclusions IEE with the SIMPLE classification achieved the quality benchmark for the resect and discard strategy; however, the NPV for rectosigmoid polyps requires improvement.

Training methods in optical diagnosis and characterization of colorectal polyps: a systematic review and meta-analysis.

Background and study aims Correct optical diagnosis of colorectal polyps is crucial to implement a resect and discard strategy. Training methods have been proposed to reach recommended optical diagnosis thresholds. The aim of our study was to present a systematic review and meta-analysis on optical diagnosis training. Methods PubMed/Medline and Cochrane databases were searched between 1980 and October 2019 for studies reporting outcomes on optical diagnosis training of colorectal polyps. The primary outcome was optical diagnosis accuracy compared to histological analysis pre-training and post-training intervention. Subgroup analyses of experienced/trainee endoscopists, training methods, and small/diminutive polyps were included. Results Overall, 16 studies met inclusion criteria, analyzing the impact of training on 179 endoscopists. Pre-training accuracy was 70.3 % (6416/9131 correct diagnoses) whereas post-training accuracy was 81.6 % (7416/9213 correct diagnoses) (risk ratio [RR] 1.17; 95 % confidence interval [CI]: 1.09–1.24, P < 0.001). In experienced endoscopists, accuracy improved from 69.8 % (3771/5403 correct diagnoses) to 82.4 % (4521/5485 correct diagnoses) (RR 1.20; 95 % CI: 1.11–1.29, P < 0.001). Among trainees, accuracy improved from 69.6 % (2645/3803 correct diagnoses) to 78.8 % (2995/3803 correct diagnoses) (RR 1.14; 95 % CI 1.06–1.24, P < 0.001). In the small/diminutive polyp subgroup, accuracy improved from 68.1 % (3549/5214 correct diagnoses) to 77.1 % (4022/5214 correct diagnoses) in (RR 1.16 95 % CI 1.08–1.24 P < 0.001). On meta-regression analysis, the improvement in accuracy did not differ between computerized vs. didactic training approaches for experienced ( P = 0.792) and trainee endoscopists ( P = 0.312). Conclusions Optical diagnosis training is effective in improving accuracy of histology prediction in colorectal polyps. Didactic and computer-based training show comparable effectiveness in improving diagnostic accuracy.

A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY

Abstract Background Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance. Aims This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent. Methods The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon 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 optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment. Results Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p &amp;lt;0.0001), 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. Conclusions The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. Funding Agencies None

A Reconfigurable SRAM Based CMOS PUF With Challenge to Response Pairs

This paper presents a reconfigurable SRAM-based physically unclonable function (PUF) topology with multiple challenge-response pairs (CRPs) per cell. The proposed PUF structure enables a very large CRP space by connecting additional pull-up and pull-down paths to each SRAM cell. These alternate pathways to the supply rail and ground are activated by the challenge inputs, which effectively reconfigure the transfer characteristics of each cross-coupled inverter. A newly proposed response instability detector improves bit error rate (BER) performance by discarding unstable response. In addition, the proposed PUF adds indirect challenges by scrambling the responses using a Galois linear feedback shift register (LFSR). The proposed PUF can be applied to a wider range of applications as a CRP PUF because it has multiple CRPs in addition to the small area and fast operating speed, which are the advantages of the conventional SRAM structure. In order to verify the performance of the proposed architecture, a 32×32-bit reconfigurable SRAM PUF array with 32-bit challenge is implemented in a 65 nm CMOS process. Experimental results show a core area of 88.867 μ m <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> /bit, energy efficiency of 0.082 pJ/bit, and inter-chip Hamming distance (HD) of 48.93% across 40 chips. By applying an unstable bit discard (UBD) scheme, BER is improved from 13.7% to 0.9%. Compared to the state-of-the-art, the proposed PUF is shown to be highly competitive in area, throughput and energy efficiency.

Uptake and barriers for implementation of the resect and discard strategy: an international survey.

Background and study aims Optical real-time diagnosis (= resect-and-discard strategy) is an alternative to histopathology for diminutive colorectal polyps. However, clinical adoption of this approach seems sparse. We were interested in evaluating potential clinical uptake and barriers for implementation of this approach. Methods We conducted an international survey using the “Google forms” platform. Nine endoscopy societies distributed the survey. Survey questions measured current clinical uptake and barriers for implementing the resect-and-discard strategy , perceived cancer risk associated with diminutive polyps and potential concerns with using CT-colonography as follow-up, as well as non-resection of diminutive polyps. Results Eight hundred and eight endoscopists participated in the survey. 84.2 % (95 % CI 81.6 %–86.7 %) of endoscopists are currently not using the resect-and-discard strategy and 59.9 % (95 % CI 56.5 %–63.2 %) do not believe that the resect-and-discard strategy is feasible for implementation in its current form. European (38.5 %) and Asian (45 %) endoscopists had the highest rates of resect-and-discard practice, while Canadian (13.8 %) and American (5.1 %) endoscopists had some of the lowest implementation rates. 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. 48.4 % (95 % CI 45.0 %–51.9 %) of endoscopists believe that leaving diminutive polyps in place is associated with increased cancer risk. This proportion was slightly higher (54.7 %; 95 % CI 53.6 %–60.4 %) when asked if current CT-colonography screening practice might increase cancer risks. Conclusion Clinical uptake of resect-and-discard is very low. Most endoscopists believe that resect-and-discard is not feasible for clinical implementation in its current form. The most important barriers for implementation are fear of making an incorrect diagnosis, assigning incorrect surveillance intervals and medico-legal consequences.

Diagnosis and Treatment of Diminutive Polyps in the Colon

Colonoscopy and polypectomy reduce the incidence and mortality of colorectal cancer (CRC) by detecting and removing colorectal adenomas. Diminutive polyps (1–5 mm) account for 75% of all polyps found but rarely contain or progress to CRC. Although a high adenoma detection rate (ADR) is associated with improved cancer prevention, the increase in detection of diminutive polyps also increases costs associated with CRC prevention programs. This review provides an update on endoscopic management and considerations related to diminutive colorectal polyps. Recent studies show that only 0–4.3% of diminutive polyps show advanced features and progression into CRC is extremely rare. Advances in endoscopic imaging have improved the ADR for screening colonoscopy, mostly as a result of greater detection of diminutive and hyperplastic polyps. A resect and discard strategy for these low-risk diminutive polyps could reduce the need for pathologic assessment and is included in society guidelines with recommendations on imaging modalities, classification, and endoscopist benchmarks. To ensure complete resection, cold snare polypectomy is emerging as the most efficient and safest method of removal. A recent guideline review showed that fecal immunochemical testing is generally the preferred first-line screening test in average-risk adults. Post-polypectomy surveillance intervals may increase in the future as evidence on the management and outcomes of diminutive polyps which is assimilated. High detection rates of diminutive polyps result in more surveillance colonoscopies and higher healthcare costs, with unclear benefit for CRC prevention. Optical diagnosis and strategies such as resect and discard may help to reduce costs. The performance of high-quality colonoscopies and strict adherence to recommended surveillance intervals will also optimize the effectiveness of screening programs.

Clinical Validation of BASIC Classification for the Resect and Discard Strategy for Diminutive Colorectal Polyps

Blue-light imaging (BLI) is a chromoendoscopy technique that uses direct (not filtered) emission of blue light with short wavelength (410 nm) to increase visibility of microvascular pattern and superficial mucosa. A BLI-based classification system for colorectal polyps (also called BLI Adenomas Serrated International Classification, BASIC) has been created and was validated using still images or short videos. We aimed to validate BASIC in a clinical practice setting, using thresholds recommended by the American Society for Gastrointestinal Endoscopy for the resect and discard strategy as the reference standard. We studied 333 patients (mean age, 62.7±8.1 y; 176 men) who underwent screening colonoscopy from January through July 2019. Six endoscopists trained in BASIC participated in the study. All detected diminutive polyps were characterized by real-time BLI and categorized as adenoma or non-adenoma according to BASIC. All polyps were removed and evaluated by histopathology. The BLI-directed surveillance intervals (based on high-confidence characterization of polyps 5 mm or smaller and pathology feature for others) were compared with histology-directed surveillance intervals, according to United States Multi-society Task Force and European Society of Gastrointestinal Endoscopy recommendations. We calculated negative-predictive values of optical real-time analysis of diminutive rectosigmoid adenomas. When we applied BASIC, 748 polyps smaller than 5 mm were categorized with 89% accuracy (95% CI, 85.9%-90.6%). BLI-directed surveillance was correct for 90% of patients according to the United States Multi-society task force criteria (95% CI, 86%-93%) and for 96% of patients according to European Society of Gastrointestinal Endoscopy criteria (95% CI, 93%-97%). The negative-predictive value for 302 polyps smaller than 5 mm, located in the rectosigmoid colon and evaluated with high confidence, based on histologic features of adenomatous polyps, was 91% (95% CI, 85%-95%). Our analysis of data from 333 patients undergoing screen colonoscopies supports the validity of BASIC discriminating diminutive colorectal polyps with histologic features of adenomas from non-adenomas. This allows for the implementation of the resect and discard strategy based on BLI in clinical practice. ClinicalTrials.gov no: NCT03746171.

205 Benefit of the Polyp Size-Based Resect and Discard Strategy for Polyp Smaller Than 10 mm in Screening Colonoscopy

INTRODUCTION: The routine histological assessment of all polyps is costly. A resect and discard small polyp has yet to be used widely in practice. Practically, a 10-year surveillance interval is recommended. Without histological confirmation for these polyps, the surveillance interval may be too long in those with a high-risk adenoma (HRA) since the guidelines recommend the 3-year interval for HRA whereas the 10-year interval for a low-risk adenoma (LRA) and no adenoma. Therefore, we aimed to determine the benefit of this strategy and the risk of hidden HRA and cancer based on only polyp size assessment. METHODS: The electronic database of 7612 screening colonoscopy between January 2007 and February 2019 was retrospectively reviewed. All polyps sized &lt;10 mm were resected and enrolled. In our practice, all identified polyps were resected and sent to a pathologist except diminutive polyps (polyp size &lt;6 mm) at the recto-sigmoid colon would have left. The size of each polyp was estimated by using opened biopsy forceps, which was 7-mm diameter. The location of polyp was classified as the proximal and distal colon. The proximal colon was defined as the region between cecum and the splenic flexure. A HRA was defined as adenoma with high-grade dysplasia, or villous adenoma. A LRA was defined as tubular adenoma. Stratification with polyp size of &lt;6 mm and 6–9 mm, the NPV for diagnosis of a HRA, and number needed for histological assessment (NNH) to detect one HRA were calculated. RESULTS: A total of 5064 polyps &lt;10 mm detected in 4419 subjects were included (Table 1). Of those, size &lt;6 mm was 4211 (83%) and size 6–9 mm was 853 (17%). Histology showed LRA in 3492 (69%) polyps, and HRA in 102 (2%) polyps (Table 1). None had cancer. The prevalence of HRA between proximal polyps and distal polyps was not different (1.7% vs. 2.3%, P = 0.16). Using only polyp size of &lt;6 mm and 6–9 mm, the NPV for diagnosis of HRA were 96.4% and 98.3%, respectively. The NNHs to detect one HRA were 60 in polyp size &lt;6 mm and 28 in polyp size 6–9 mm (Table 2). At $50 per specimen, the polyp size-based resect and discard strategy could save $57,298 for each 1000 subjects with at least one polyp &lt;10 mm. CONCLUSION: In a country with financial constrain, resecting polyp &lt;10 mm without histological assessment is recommended because there was no risk for missing cancer and this strategy achieved the Preservation and Incorporation of Valuable Endoscopic Innovation (PIVI) threshold with NPV at 96% for the HRA.

Factors that influence discarding in the Gulf of Mexico commercial grouper-tilefish IFQ reef fish fishery

Factors potentially affecting fish discarding were evaluated for species managed under the Gulf of Mexico grouper-tilefish individual fishing quota (GT-IFQ) program. Thirteen commercially important species are managed under the GT-IFQ program. Some of the more commonly caught species in the program include red grouper (Epinephelus morio), gag (Mycteroperca microlepis), speckled hind (Epinephelus drummondhayi), golden tilefish (Lopholatilus chamaeleonticeps), and blueline tilefish (Caulolatilus microps). It is necessary to determine why discards are occurring to develop a future discard mitigation strategy. Logistic models were constructed using data from the Southeast Fisheries Science Center’s (SEFSC) Reef Fish Observer Program (RFOP) with covariates of fish length, available allocation, gear type, calendar year quarter, and year to infer reasons for discarding. The results from RFOP models in conjunction with self-reported discard information from the SEFSC Supplemental Discard Logbook program determined that discarding due to fish length selection, not related to minimum a size limit, is occurring for golden tilefish, speckled hind, yellowedge grouper (Epinephelus flavolimbatus), and snowy grouper (Hyporthodus niveatus). Other dynamics such as multi-species quota discarding are likely responsible for discards of blueline tilefish. Based on the results of the study, potential changes to the GT-IFQ program such as additional flexibility measures were identified as potential management strategies for decreasing discards. A similar approach to inferring why discarding is occurring could be used in the other regions for more effective management promoting long-term sustainability of valuable fisheries.

Should We Resect and Discard Low Risk Diminutive Colon Polyps.

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.