title: Resect and discard approach to colon polyps: real-world applicability among academic and community gastroenterologists.
abstract: BACKGROUND
  "Resect and discard" (RD) is a new paradigm for management of diminutive polyps.
  
  
  OBJECTIVE
  To compare concordance of surveillance interval recommendations and diagnostic performance between RD and standard of care in a hospital outpatient department with both academic and community gastroenterologists.
  
  
  METHODS
  Prospective, observational study conducted at a single outpatient endoscopy center over 12 months. Patients with diminutive polyps on screening or surveillance colonoscopy were included. Histology predictions for all diminutive polyps (≤5 mm) were made based on endoscopic imaging. Concordance of recommended surveillance intervals and diagnostic performance of histology predictions were compared to histopathological review.
  
  
  RESULTS
  A total of 606 diminutive polyps were found in 315 patients (mean age 62.4 years, 49 % female). Histological prediction was made in 95.7 % of polyps (97.4 % of patients), with high confidence in 74.3 %. The concordance for surveillance intervals was 82.1 % compared to histopathological review and was similar between community and academic gastroenterologists (80.2 vs. 76.3 %, p = 0.38). Overall, sensitivity, specificity, and accuracy of histological predictions made with high confidence were 0.81, 0.36, and 77.1 %. Predictions made with narrow-band imaging (NBI) had lower accuracy (73.9 % with NBI vs. 82.5 % with high-definition white light (HWDL) only, p = 0.017) as well as lower prediction confidence (score of 7.6 with NBI vs. 8.6 with HDWL only, p < 0.001).
  
  
  CONCLUSIONS
  Our surveillance interval concordance was below the 90 % threshold deemed acceptable by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations statement. Diagnostic performance using optical imaging to predict histology was equal between community and academic endoscopists.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Washington University, 660 S. Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA, susanvu@gmail.com.
authors.forename: Hongha T
authors.initials: HT
authors.lastname: Vu
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Hollander
authors.forename: Jennifer
authors.initials: J
authors.lastname: Clebanoff
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Chandra P
authors.initials: CP
authors.lastname: Gyawali
authors.forename: Erik P
authors.initials: EP
authors.lastname: Thyssen
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Weinstock
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000236:Adenoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D001706:Biopsy; D003082:Colectomy; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy / Q000592:standards; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D003153:Community Health Services / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D010044:Outpatient Clinics, Hospital; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden