Clin Endosc.  2013 Mar;46(2):130-137. 10.5946/ce.2013.46.2.130.

New Paradigms for Colonoscopic Management of Diminutive Colorectal Polyps: Predict, Resect, and Discard or Do Not Resect?

• Hassan C
• Repici A
• Zullo A
• Sharma P

• KMID: 1805294
• DOI: http://doi.org/10.5946/ce.2013.46.2.130

Abstract

The possibility to predict in vivo the histology of colorectal polyps by advanced endoscopic imaging has resulted in the implementation of a more conservative management for diminutive lesions detected at colonoscopy. In detail, a predict-and-do-not-resect strategy has been proposed for diminutive lesions located in the rectosigmoid tract, whilst a predict-resect-and-discard policy has been advocated for nonrectosigmoid diminutive polyps. Recently, the American Society for Gastrointestinal Endoscopy set required thresholds to be met, before allowing the adoption of these policies in the clinical field. The ability of current endoscopic imaging in reaching these thresholds would depend on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended. Aim of this review is to summarize the data supporting the application of both a predict-and-do-not-resect and a predict-resect-and-discard policies, also addressing the potential pitfalls associated with these strategies.

Keyword

Electronic chromoendoscopy; Colonoscopy; Polypectomy; Narrow band imaging; Preservation and incorporation of valuable endoscopic innovation

MeSH Terms

Adoption
Colonoscopy
Endoscopy, Gastrointestinal
Narrow Band Imaging
Polyps
Prevalence

Figure

• 

  Fig. 1 Summary algorithm of the electronic chromoendoscopy (EC)-based proposed strategies according to American Society for Gastrointestinal Endoscopy recommendations.62

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