Colonic Polyps

Colorectal cancer represents a major cause of mortality in Western countries, and population-based colonoscopy screening is supported by official guidelines. A significant determinant of the cost of colonoscopy screening/surveillance is driven by polypectomy of diminutive (≤5 mm) lesions. When considering the low prevalence of advanced neoplasia within diminutive polyps, the additional cost of pathologic examination is mainly justified by the need to differentiate between precancerous adenomatous versus hyperplastic polyps. The aim of this review is to summarize the data supporting the clinical application of a resect and discard strategy, also addressing the potential pitfalls associated with this approach.

Key points

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The very low prevalence of advanced neoplasia in diminutive lesions supports the safety of resect and discard or discard policies.
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Although dye-chromoendoscopy or electronic chromoendoscopy at high magnification seem accurate for in vivo polyp prediction, they seem unfeasible in Western countries. Low-magnification electronic chromoendoscopy seems simple to be implemented in these countries, and an adequate, albeit variable, accuracy has been shown.
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The ability of low-magnification electronic chromoendoscopy in meeting American Society for Gastrointestinal Endoscopy thresholds is uncertain, depending on disease prevalence, technical accuracy, and the surveillance interval adopted for low-risk adenomas.