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

Table 1 The polyp-based resect and discard strategy

Scenario	Rule		If family history of CRC (first-degree relative)
		Surveillance interval recommendation based on 2012 guidelines, yr
1	No polyp	10	5
2	1–2 diminutive polyps (largest polyp max 5 mm)	10	5
3	1–3 small polyps (all polyps 1–9 mm and the largest polyp max < 10 mm)	5	5
4	≥ 4 polyps, any size	Follow-up pathology results	-
5	At least 1 polyp ≥ 10 mm	Follow-up pathology results	-
6	Insufficient or inadequate bowel preparation	1	-
7	Unclear	-	-
		Surveillance interval recommendation based on 2020 guidelines, yr
1	No polyp	10	5
2	1–3 diminutive polyps; or 2 diminutive polyps and 1 small polyp	10	5
3	1–2 small polyps exclusively	10	5
4	> 3 polyps, any size, or > 2 polyps 6–9 mm	Follow-up pathology results	–
5	≥ 1 polyp ≥ 10 mm	Follow-up pathology results	–
6	Insufficient or inadequate bowel preparation	1	1

CRC: Colorectal cancer.

Table 2 Patient, procedure, and polyp characteristics¹ (mean ± SD)

Characteristics
Patients, n	944
Age, yr	62.6 (8.6)
Male sex, n (%)	465 (49.3)
Family history of CRC2, n (%)
No	682 (72.2)
Yes	259 (27.4)
Colonoscopy indication, n (%)
Screening	299 (31.7)
FIT+	39 (4.1)
Adenoma surveillance	206 (21.8)
Anemia/bleeding	158 (16.7)
Diarrhea	28 (3.0)
Other	214 (22.7)
Procedures
Bowel preparation quality, n (%)
Adequate	851 (90.1)
Inadequate3	93 (9.9)
Cecal intubation rate, n (%)	902 (95.6)
Polyp detection rate4, %	53.7%
Adenoma detection rate4, %	36.4%
Polyps, n	933
Polyp size, mm	5.8 (8.3)
Polyp size, n (%)
≤ 5 mm	689 (73.8)
6–9 mm	130 (13.9)
≥ 10 mm	114 (12.2)
Histopathology, n (%)
Hyperplastic polyp	274 (29.4)
Tubular adenoma	468 (50.2)
Villous adenoma	36 (3.9)
Traditional serrated adenoma	1 (0.1)
Sessile serrated adenoma/polyp	38 (4.1)
Other	103 (11.0)
High-grade dysplasia	13 (1.4)
Tubular adenoma with HGD	3/13 (23.1)
Villous adenoma with HGD	10/13 (76.9)
Optical histology prediction based on NICE classification	842/933 (90.2)5
Non-neoplastic	345 (41.0)
Neoplastic	497 (59.0)
High-confidence optical diagnosis	648 (69.5)

¹Patients with at least 1 ≤ 10 mm polyp.

²Unknown family history of CRC = 3 (0.3%).

³Defined as Boston bowel preparation score < 6.

⁴Defined as percentage of patients where at least 1 polyp/adenoma was found.

⁵All polyps were ≤ 10 mm.

CRC: Colorectal cancer; FIT: Fecal immunochemical test; HGD: High-grade dysplasia; NICE: Narrow-band imaging international colorectal endoscopic.

Table 3 Concordance between endoscopist polyp-based resect and discard strategy and post-hoc polyp-based resect and discard surveillance interval assignment compared with histopathology¹

Endoscopist PBRD	Post-hoc PBRD			P value
	Shorter	Correct	Longer
Shorter	54	89	3	< 0.0001a
Correct	1	714	3
Longer	0	51	28

¹Surveillance intervals based on the 2012 guideline.

^aP < 0.05.

PBRD: Polyp-based resect and discard.