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Should We Resect and Discard Low Risk Diminutive Colon Polyps

Michael B. Wallace|Pujan Kandel
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2019.05|Clinical Endoscopy|제52권 제3호|pp. 239-246|DOI 10.5946/ce.2018.136

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참고문헌

키워드

Colorectal polyps
주제분류내과학

초록

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection withhistological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis withouthistology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal EndoscopyPreservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplasticpolyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive valueshould be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be suffcientlyaccurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosisat least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regardto 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-qualitytraining, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose ofcolorectal polyps and its implications for colonoscopy practice.

Abstract

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection withhistological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis withouthistology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal EndoscopyPreservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplasticpolyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive valueshould be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be suffcientlyaccurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosisat least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regardto 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-qualitytraining, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose ofcolorectal polyps and its implications for colonoscopy practice.

참고문헌 (58)

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관련 논문AI추천

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