![]() ![]() One paradigm describes endoscopic resection of colorectal polyps without submitting them for pathological assessment (“resect and discard”) while the other paradigm describes to leave diminutive hyperplastic rectosigmoid polyps in place without resection. Recently, the American Society for Gastrointestinal Endoscopy (ASGE) proposed two new paradigms for the management of diminutive polyps in the so called PIVI-statement. The annual up-front cost savings in the US of forgoing the pathologic assessment would exceed one billion dollars per year. However, this routine pathologic evaluation of all resected diminutive polyps results in considerable costs to the health care system for the management of a group of lesions which eventually have only limited clinical significance. Since conventional white-light endoscopy cannot reliably distinguish histological features of colorectal polyps, it is standard practice to remove all polyps for histopathological evaluation. Therefore, histology of diminutive polyps is mostly used to guide post-polypectomy surveillance. However, diminutive polyps have a very low prevalence of advanced histologic features and their cancer prevalence ranges between 0 and 0.08 %. Trial registrationĭistal diminutive polyps (polyps ≤ 5 mm) are frequently observed in daily clinical routine and can be found in more than 50 % of the screening population. This approach has the potential to reduce costs and risks associated with the redundant removal of diminutive colorectal polyps. High-definition endoscopy in combination with digital chromoendoscopy allowed real-time in vivo prediction of distal colorectal polyp histology and is accurate enough to leave distal colorectal polyps in place without resection or to resect and discard them without pathologic assessment. Surveillance intervals with digital chromoendoscopy were correctly predicted with >90 % accuracy. In high-confidence predictions, the accuracy increased to 96.3 % while sensitivity, specificity, positive and negative predictive values were calculated as 98.1, 94.4, 94.5, and 98.1 %, respectively. Sensitivity, specificity, positive and negative predictive values were 93.3, 88.7, 88.7, and 93.2 %, respectively. ![]() The overall accuracy of digital chromoendoscopy for prediction of adenomatous polyp histology was 90.1 %. Real time histology of 121 diminutive distal colorectal polyps was evaluated using high-definition endoscopy with digital chromoendoscopy and the accuracy of predicting histology with digital chromoendoscopy was assessed. In this prospective cohort study, 224 consecutive patients undergoing screening or surveillance colonoscopy were included. Within this study we assessed whether digital chromoendoscopy can accurately predict the histology of distal diminutive colorectal polyps according to the ASGE PIVI statement. Distal diminutive colorectal polyps are common and accurate endoscopic prediction of hyperplastic or adenomatous polyp histology could reduce procedural time, costs and potential risks associated with the resection.
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