Formal polyp histology does not alter surveillance intervals predicted at the time of colonoscopy/polypectomy with high-definition endoscopes

Abstract

Histology of resected polyps remains a major determinant of surveillance intervals; however, it is costly and not available to patients at the time of their procedure. With improvement in technology and endoscopic diagnosis of polyps, this is now a feasible endpoint. The aim of the study was to determine the accuracy of predicted surveillance intervals at the time of colonoscopy, dictated by number, size, predicted histology and clinical/family history in patients with polyps resected, as per Australian guidelines. Seven hundred and thirty consecutive patients who underwent colonoscopy performed by a single experienced endoscopist from January to October 2020 in both the public and private sectors in Central Coast, New South Wales were prospectively analysed and included. Three hundred and thirty three patients without adenomatous polyps were excluded. Patient demographics, number and size of adenomas per patient, method of polyp resection, predicted surveillance interval and degree of confidence (high or low) of this interval based on endoscopic prediction of histology, and formal histology of polyp(s) were recorded prospectively. The primary endpoint was accuracy of the predicted surveillance interval as per Australian guidelines. The predicted surveillance interval was correct as per Australian guidelines in 94.2% of patients once formal histology was obtained. When considering patients whose intervals were predicted with high confidence only, predicted surveillance was accurate in 98.1% of patients. This study demonstrates that formal histology does not alter the surveillance intervals in almost all patients, especially when predicted with high confidence and when optimal techniques are employed by an experienced endoscopist.