SP 11.13 Extending “Resect and Discard” Beyond Screening: Feasibility for Small and Diminutive Colorectal Polyps in All-Comers
Sithdharthan Ravikumar, Shashikanth Vijayaraghavalu, Namrata Aravindan, Sanjana Susarla, Aravindan NarayananAbstract
Aim
Most colorectal polyps removed at colonoscopy are diminutive or small and rarely show advanced pathology. Routine histology for these low-risk lesions creates significant cost and workload with limited clinical benefit. This study evaluates outcomes for diminutive and small polyps in screening and symptomatic cohorts and assesses the feasibility of extending a “resect and discard” strategy using optical diagnosis beyond current screening practice.
Methods
A retrospective review was conducted using the Unisoft endoscopy database and electronic patient records between November 2024 and March 2025. Small and diminutive polyps were evaluated using white-light endoscopy and narrow band imaging (NBI), with subsequent comparison against histopathological findings. Polyps > 9 mm were excluded.
Results
A total of 350 consecutive polypectomies were reviewed, with 120 excluded (>9 mm). Of the remaining 230 resections, 189 polyps were identified as tubular adenomas or serrated lesions measuring >5 mm located outside the rectum, while 41 were serrated polyps <5 mm within the rectum. No malignant polyps were detected. Polypectomy findings influenced surveillance recommendations in 10% of cases. No statistically significant association was observed between endoscopic visual assessment (white light, NBI, Paris classification and Kudo pattern) and final histological diagnosis.
Conclusion
Optical diagnosis has potential to reduce histopathology workload and cost savings without compromising patient safety for small and diminutive colorectal polyps. Expanding the “resect and discard” strategy to include both screening and symptomatic populations may be achievable, provided endoscopists receive structured training and apply validated optical classification systems such as NICE, supported by ongoing audit and quality assurance.