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

作　　者：Mahsa Taghiakbari Celia Hammar Mira Frenn Roupen Djinbachian Heiko Pohl Erik Deslandres Simon Bouchard Mickael Bouin Daniel von Renteln 

机构地区：[1]Department of Gastroenterology,Montreal University Hospital Research Center(CRCHUM),Montréal H2X 0A9,Quebec,Canada [2]Department of Gastroenterology,University of Montreal,Faculty of Medicine,Montreal H2X 0A9,Quebce,Canada [3]Department of Internal Medicine,University of Montreal Hospital Center(CHUM),Montreal H2X 0A9,Quebec,Canada [4]Department of Medicine,Veterans Affairs Medical Center,White River Junction,VT 05009,United States [5]Department of Gastroenterology,Dartmouth Geisel School of Medicine and The Dartmouth Institute,Hanover,NH 03755,United States

出　　处：《World Journal of Gastroenterology》2022年第19期2137-2147,共11页世界胃肠病学杂志（英文版）

基　　金：The study protocol and data collection were approved by the local institutional research board as an amendment to the two prospective clinical studies(17.135 and 16.367,respectively).

摘　　要：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.

关 键 词：COLONOSCOPY Colorectal pathology Colorectal adenomas ENDOSCOPY Surveillance Optical diagnosis 

分 类 号：R656.9[医药卫生—外科学]