Abstract
The “Resect and Discard” strategy, which omits formal pathological diagnosis of certain lesions based on endoscopic diagnosis with high confidence, is a promising proposal to reduce costs and efforts related to pathological diagnosis after polypectomy for adenoma, as well as reduce adverse events and costs related to unnecessary polypectomy for hyperplastic polyps. However, this strategy requires 1) accurate differentiation between a non-neoplastic lesion and neoplastic lesion, and 2) precise diagnosis of small or diminutive invasive cancers, when it is adapted to clinical practice. The American Society of Gastrointestinal Endoscopy recommends that the target lesion in the United States should be colorectal polyps ≤ 5mm in size, and the technology used in the strategy should satisfy the following two thresholds : 1) >90% agreement in determining post-polypectomy surveillance intervals compared with decisions based on pathologic assessment, and 2) ≥90% negative predictive value for rectosigmoid polyps (when used with high confidence) with adenomatous histology.
Although the “Resect and Discard” strategy still has problems to be solved, such as the education system, it has enough reasons to be realized because the final goal of endoscopic diagnosis is real-time pathological diagnosis in vivo. Therefore, we should watch the movement of this strategy carefully.
