title: Management of Diminutive Colon Polyps Based on Endoluminal Imaging.
abstract: Diminutive colon polyps, defined as 5 mm or less, are encountered increasingly at colonoscopy. The risk of serious pathology in such polyps is low. There is a risk and cost of resecting all such polyps and sending tissue for pathologic evaluation. Enhancement of endoluminal imaging may enable discrimination of neoplastic vs non-neoplastic polyps. If this discrimination can be performed accurately with high confidence, it may be possible to either resect and discard diminutive adenomas, or inspect and do-not-resect diminutive hyperplastic polyps. In 2011, an expert group recommended thresholds of 90% negative predictive value for adenomas, and 90% accuracy in predicting appropriate surveillance intervals. Since 2011, criteria for polyp discrimination have been published and validated by experts and nonexperts. In vivo studies have been performed to compare endoscopic impression and pathologic diagnosis. An expert panel was convened in late 2014 to review the literature to determine if the proposed thresholds for discrimination can be attained and to recommend the next steps for introducing changes in clinical practice. We conclude that threshold levels can be achieved with several endoscopic image enhancements. The next steps to implementation of practice change include acquiring data on training and competence, determining best practices for auditing performance, understanding patient education needs, and the potential cost benefit of such changes.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR. Electronic address: lieberma@ohsu.edu.
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.affiliation: Predictive Health, LLC, Paradise Valley, AZ.
authors.forename: Joel
authors.initials: J
authors.lastname: Brill
authors.affiliation: Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD.
authors.forename: Marcia
authors.initials: M
authors.lastname: Canto
authors.affiliation: Department of Medicine, Division of Gastroenterology, Baylor University Medical Center, Dallas, TX.
authors.forename: Daniel
authors.initials: D
authors.lastname: DeMarco
authors.affiliation: Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR.
authors.forename: Brian
authors.initials: B
authors.lastname: Fennerty
authors.affiliation: Department of Medicine, Division of Gastroenterology, Loyola University Health System, Chicago, IL.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Division of Gastroenterology, Yale University of Medicine, New Haven, CT.
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
authors.affiliation: Department of Medicine, Division of Gastroenterology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY.
authors.forename: Charles
authors.initials: C
authors.lastname: Lightdale
authors.affiliation: Department of Medicine, Division of Gastroenterology, Johns Hopkins Medical Laboratories, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.affiliation: Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Odze
authors.affiliation: Department of Medicine, Division of Gastroenterology, Indiana University Medical Center, Indianapolis, IN.
authors.forename: Douglas
authors.initials: D
authors.lastname: Rex
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, KS.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kochman
authors.affiliation: Temple/Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
mesh_terms: D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D061848:Optical Imaging / Q000379:methods*; D011127:Polyps / Q000175:diagnosis* / Q000601:surgery*
keywords: Adenomatous Polyp; Colonoscopy; Hyperplastic Polyp