The "diagnose and leave in" strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial
Por:
Rivero-Sanchez, L, Gavric, A, Herrero, J, Remedios, D, Alvarez, V, Albeniz, E, Gordillo, J, Puig, I, Lopez-Vicente, J, Huerta, A, Lopez-Ceron, M, Salces, I, Penas, B, Parejo, S, Rodriguez, E, Herraiz, M, Carretero, C, Gimeno-Garcia, AZ, Saperas, E, Alvarez, C, Arnau-Collell, C, Ortiz, O, Sanchez, A, Jung, G, Balaguer, F, Pellise, M
Publicada:
1 ene 2022
Ahead of Print:
1 feb 2021
Resumen:
Background The "diagnose-and-leave-in" policy has been established to reduce the risks and costs related to unnecessary polypectomies in the average-risk population. In individuals with Lynch syndrome, owing to accelerated carcinogenesis, the general recommendation is to remove all polyps, irrespective of size, location, and appearance. We evaluated the feasibility and safety of the diagnose-and-leave-in strategy in individuals with Lynch syndrome.
Methods We performed a post hoc analysis based on per-polyp data from a randomized, clinical trial conducted by 24 dedicated colonoscopists at 14 academic centers, in which 256 patients with confirmed Lynch syndrome underwent surveillance colonoscopy from July 2016 to January 2018. In vivo optical diagnosis with confidence level for all detected lesions was obtained before polypectomy using virtual chromoendoscopy alone or with dye-based chromoendoscopy. Primary outcome was the negative predictive value (NPV) for neoplasia of high-confidence optical diagnosis among diminutive (<= 5mm) rectosigmoid lesions. Histology was the reference standard.
Results Of 147 rectosigmoid lesions, 128 were diminutive. In 103 of the 128 lesions (81%), the optical diagnostic confidence was high and showed an NPV of 96.0% (95% confidence interval [CI] 88.9%-98.6%) and accuracy of 89.3% (95%CI 81.9%-93.9%). By following the diagnose-and-leave-in policy, we would have avoided 59% (75/128) of polypectomies at the expense of two diminutive low grade dysplastic adenomas and one diminutive sessile serrated lesion that would have been left in situ.
Conclusion In patients with Lynch syndrome, the diagnose-and-leave-in strategy for diminutive rectosigmoid polyps would be feasible and safe.
Filiaciones:
Rivero-Sanchez, L:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Gavric, A:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Univ Med Ctr Ljubljana, Dept Gastroenterol & Hepatol, Ljubljana, Slovenia
Herrero, J:
Complexo Hosp Univ Ourense, Inst Invest Biomed Galicia Sur, CIBERehd, Gastroenterol, Orense, Spain
Remedios, D:
Complexo Hosp Univ Ourense, Inst Invest Biomed Galicia Sur, CIBERehd, Gastroenterol, Orense, Spain
Alvarez, V:
Complexo Hosp Pontevedra, Digest Dept, Pontevedra, Spain
Albeniz, E:
Univ Publ Navarra, IdiSNa, Complejo Hosp Navarra, Digest Syst Serv,Endoscopy Unit,Navarrabiomed, Pamplona, Spain
Gordillo, J:
Hosp Santa Creu & Sant Pau, Gastroenterol Unit, Barcelona, Spain
Puig, I:
Xarxa Assistencial Univ Manresa, Gastroenterol Dept, Althaia, Manresa, Spain
Lopez-Vicente, J:
Hosp Univ Mostoles, Digest Syst Serv, Madrid, Spain
Huerta, A:
Hosp Galdakao Usansolo, Dept Gastroenterol, Galdakao, Spain
Lopez-Ceron, M:
Hosp Univ 12 Octubre, Digest Syst Serv, Madrid, Spain
Salces, I:
Hosp Univ 12 Octubre, Digest Syst Serv, Madrid, Spain
Penas, B:
Hosp Univ Ramon y Cajal, Dept Gastroenterol, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Parejo, S:
Hosp Univ Ramon y Cajal, Dept Gastroenterol, Madrid, Spain
Rodriguez, E:
Hosp Univ Ramon y Cajal, Dept Gastroenterol, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Herraiz, M:
Univ Navarra Clin, Gastroenterol Dept, IdiSNA, Pamplona, Spain
Carretero, C:
Univ Navarra Clin, Gastroenterol Dept, IdiSNA, Pamplona, Spain
Gimeno-Garcia, AZ:
Hosp Univ Canarias, Gastroenterol Dept, Santa Cruz De Tenerife, Spain
Saperas, E:
Hosp Gen Cataluna, Gastroenterol Dept, Sant Cugat Del Valles, Spain
Alvarez, C:
Hosp del Mar, Gastroenterol Dept, Barcelona, Spain
Arnau-Collell, C:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ortiz, O:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Sanchez, A:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Jung, G:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Balaguer, F:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
Pellise, M:
Hosp Clin Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAP, Dept Gastroenterol, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain
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