A survey of patient acceptance of resect and discard for diminutive polyps

      Background and Aims

      Resect and discard is a new paradigm for management of diminutive colon polyps. Little is known regarding whether patients would accept resect and discard. We surveyed colonoscopy patients and their drivers regarding acceptance of resect and discard.

      Methods

      This was a cross-sectional survey of colonoscopy outpatients and their drivers at two outpatient academic endoscopy centers.

      Results

      Four hundred fifteen colonoscopy patients and 293 drivers completed the survey (93.5% of all invited participants). Results for the two groups were similar. Overall, 66.3% indicated they would accept resect and discard. Participants who were younger, white, and seen at the ambulatory surgery center (vs the hospital outpatient department) were more likely to accept. Those declining resect and discard were more likely to be willing to pay some amount out-of-pocket to have diminutive polyps checked by pathology (97.1% vs 44.5%). Of those unwilling to accept resect and discard, 49.8% would require a zero chance of cancer in diminutive polyps before accepting resect and discard.

      Conclusions

      Patient acceptance of resect and discard appears promising but is quite variable. Eliciting individual patient acceptance of resect and discard will be important during initial implementation into clinical practice.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rex D.K.
        Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps.
        Gastroenterology. 2009; 136: 1174-1181
        • Ignjatovic A.
        • East J.E.
        • Suzuki N.
        • et al.
        Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect inspect characterise resect and discard; DISCARD trial): a prospective cohort study.
        Lancet Oncol. 2009; 10: 1171-1178
        • Kessler W.R.
        • Imperiale T.F.
        • Klein R.W.
        • et al.
        A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps.
        Endoscopy. 2011; 43: 683-691
        • Hassan C.
        • Pickhardt P.J.
        • Rex D.K.
        A resect and discard strategy would improve cost-effectiveness of colorectal cancer screening.
        Clin Gastroenterol Hepatol. 2010; 8 (9 e1-3): 865-869
        • McGill S.K.
        • Evangelou E.
        • Ioannidis J.P.
        • et al.
        Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics.
        Gut. 2013; 62: 1704-1713
        • Wanders L.K.
        • East J.E.
        • Uitentuis S.E.
        • et al.
        Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis.
        Lancet Oncol. 2013; 14: 1337-1347
        • Rex D.K.
        • Kahi C.
        • O'Brien M.
        • et al.
        The American Society for Gastrointestinal Endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps.
        Gastrointest Endosc. 2011; 73: 419-422
        • Chaput U.
        • Alberto S.F.
        • Terris B.
        • et al.
        Risk factors for advanced adenomas amongst small and diminutive colorectal polyps: a prospective monocenter study.
        Dig Liver Dis. 2011; 43: 609-612
        • Gupta N.
        • Bansal A.
        • Rao D.
        • et al.
        Prevalence of advanced histological features in diminutive and small colon polyps.
        Gastrointest Endosc. 2012; 75: 1022-1030
        • Shapiro R.
        • Ben-Horin S.
        • Bar-Meir S.
        • et al.
        The risk of advanced histology in small-sized colonic polyps: Are non-invasive colonic imaging modalities good enough?.
        Int J Colorectal Dis. 2012; 27: 1071-1075
        • Tsai F.C.
        • Strum W.B.
        Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size.
        Dig Dis Sci. 2011; 56: 2384-2388
        • Unal H.
        • Selcuk H.
        • Gokcan H.
        • et al.
        Malignancy risk of small polyps and related factors.
        Dig Dis Sci. 2007; 52: 2796-2799
        • Bretagne J.F.
        • Manfredi S.
        • Piette C.
        • et al.
        Yield of high-grade dysplasia based on polyp size detected at colonoscopy: a series of 2295 examinations following a positive fecal occult blood test in a population-based study.
        Dis Colon Rectum. 2010; 53: 339-345
        • Lieberman D.
        • Moravec M.
        • Holub J.
        • et al.
        Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.
        Gastroenterology. 2008; 135: 1100-1105
        • Lawrance I.C.
        • Sherrington C.
        • Murray K.
        Poor correlation between clinical impression, the small colonic polyp and their neoplastic risk.
        J Gastroenterol Hepatol. 2006; 21: 563-568
        • Butterly L.F.
        • Chase M.P.
        • Pohl H.
        • et al.
        Prevalence of clinically important histology in small adenomas.
        Clin Gastroenterol Hepatol. 2006; 4: 343-348
        • Church J.M.
        Clinical significance of small colorectal polyps.
        Dis Colon Rectum. 2004; 47: 481-485
        • Fong T.V.
        • Chuah S.K.
        • Chiou S.S.
        • et al.
        Correlation of the morphology and size of colonic polyps with their histology.
        Chang Gung Med J. 2003; 26: 339-343
        • Aldridge A.J.
        • Simson J.N.
        Histological assessment of colorectal adenomas by size. Are polyps less than 10 mm in size clinically important?.
        Euro J Surg (Acta Chirurgica). 2001; 167: 777-781
        • Silva S.M.
        • Rosa V.F.
        • Santos A.C.
        • et al.
        Influence of patient age and colorectal polyp size on histopathology findings.
        Brazil Arch Digest Surg. 2014; 27 ([Portuguese]): 109-113
        • Rex D.K.
        Prediction of colorectal polyp pathologic lesions with image-enhanced endoscopy: What will it take to make it matter?.
        Gastrointest Endosc. 2014; 80: 1088-1093