title: Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals.
abstract: BACKGROUND
  Polyps identified at colonoscopy are predominantly diminutive (<5 mm) with a small risk (>1%) of high-grade dysplasia or carcinoma; however, the cost of histological assessment is substantial.
  
  
  OBJECTIVE
  The aim of this study was to determine whether prediction of colonoscopy surveillance intervals based on real-time endoscopic assessment of polyp histology is accurate and cost effective.
  
  
  METHODS
  A prospective cohort study was conducted across a tertiary care and private community hospital. Ninety-four patients underwent colonoscopy and polypectomy of diminutive (≤5 mm) polyps from October 2012 to July 2013, yielding a total of 159 polyps. Polyps were examined and classified according to the Sano-Emura classification system. The endoscopic assessment (optical diagnosis) of polyp histology was used to predict appropriate colonoscopy surveillance intervals. The main outcome measure was the accuracy of optical diagnosis of diminutive colonic polyps against the gold standard of histological assessment.
  
  
  RESULTS
  Optical diagnosis was correct in 105/108 (97.2%) adenomas. This yielded a sensitivity, specificity and positive and negative predictive values (with 95%CI) of 97.2% (92.1-99.4%), 78.4% (64.7-88.7%), 90.5% (83.7-95.2%) and 93% (80.9-98.5%) respectively. Ninety-two (98%) patients were correctly triaged to their repeat surveillance colonoscopy. Based on these findings, a cut and discard approach would have resulted in a saving of $319.77 per patient.
  
  
  CONCLUSIONS
  Endoscopists within a tertiary care setting can accurately predict diminutive polyp histology and confer an appropriate surveillance interval with an associated financial benefit to the healthcare system. However, limitations to its application in the community setting exist, which may improve with further training and high-definition colonoscopes.
authors.affiliation: Departments of Gastroenterology, Austin Health, Melbourne, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Anaesthetics, Austin Health, Melbourne, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Parker
authors.affiliation: Departments of Gastroenterology, Austin Health, Melbourne, Australia.|Department of Gastroenterology, Warringal Private Hospital, Melbourne, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Lontos
authors.affiliation: Departments of Gastroenterology, Austin Health, Melbourne, Australia.|Department of Gastroenterology, Warringal Private Hospital, Melbourne, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Vaughan
authors.affiliation: Departments of Gastroenterology, Austin Health, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Efthymiou
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000473:pathology; D003113:Colonoscopy / Q000191:economics*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: colonic neoplasm; colonoscopy; cost-benefit analysis; histology; polyps