Surgical endoscopy · 2026
A "resect and discard" strategy with risk-stratified management based on polyp diameter, number, and resection history.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Huang Min, Sun Lu, Weng Yaping, Hu Hulan, Yang Qingfeng, Lei Jiacai, Tang Weihong, Han Liang
Аннотация
BACKGROUND: Current "resect and discard" strategies, which rely on advanced optical diagnosis or artificial intelligence, face challenges in widespread adoption because of high technological and equipment requirements.
METHODS: We retrospectively analyzed data from patients who underwent complete endoscopic resection of colorectal polyps with a definitive pathological diagnosis at Hangzhou Ninth Hospital between May 2015 and July 2025. Different "resect and discard" strategies and recommended endoscopic follow-up intervals were formulated based on polyp diameter and number. The concordance between the follow-up intervals suggested by our strategy and those recommended by current pathology-based guidelines was analyzed. This strategy was further validated in patients who underwent follow-up after their initial polypectomy.
RESULTS: A total of 7,265 patients (mean age 56.34 years, 63.0% male) with 10,004 polyps were included in the study. Polyps ≤ 5 mm constituted the greatest proportion (86.4%), while the incidence of high-risk polyps was low (0.35%). The "resect and discard" strategy applied to patients with 1-2 polyps ≤ 5 mm demonstrated high applicability (80.11%) and excellent agreement with guideline-recommended surveillance intervals (99.59%; 95% CI: 0.994-0.997). A significant difference was observed in the proportion of high-risk polyps among resected 6-9 mm polyps between patients who underwent their first polypectomy and those in the surveillance phase (22.41% vs. 3.45%, P < 0.001). For surveillance patients with 1-2 polyps < 10 mm, the concordance of the "resect and discard" strategy with the guidelines improved by approximately 99.48% (95% CI: 0.989-1.000).
CONCLUSION: In patients with 1-2 polyps ≤ 5 mm, the "resect and discard" strategy demonstrates both excellent feasibility and safety, and the follow-up period is 99.59% consistent with the guidelines. Furthermore, the scope of this strategy can be safely expanded for patients undergoing polypectomy during postresection surveillance.
METHODS: We retrospectively analyzed data from patients who underwent complete endoscopic resection of colorectal polyps with a definitive pathological diagnosis at Hangzhou Ninth Hospital between May 2015 and July 2025. Different "resect and discard" strategies and recommended endoscopic follow-up intervals were formulated based on polyp diameter and number. The concordance between the follow-up intervals suggested by our strategy and those recommended by current pathology-based guidelines was analyzed. This strategy was further validated in patients who underwent follow-up after their initial polypectomy.
RESULTS: A total of 7,265 patients (mean age 56.34 years, 63.0% male) with 10,004 polyps were included in the study. Polyps ≤ 5 mm constituted the greatest proportion (86.4%), while the incidence of high-risk polyps was low (0.35%). The "resect and discard" strategy applied to patients with 1-2 polyps ≤ 5 mm demonstrated high applicability (80.11%) and excellent agreement with guideline-recommended surveillance intervals (99.59%; 95% CI: 0.994-0.997). A significant difference was observed in the proportion of high-risk polyps among resected 6-9 mm polyps between patients who underwent their first polypectomy and those in the surveillance phase (22.41% vs. 3.45%, P < 0.001). For surveillance patients with 1-2 polyps < 10 mm, the concordance of the "resect and discard" strategy with the guidelines improved by approximately 99.48% (95% CI: 0.989-1.000).
CONCLUSION: In patients with 1-2 polyps ≤ 5 mm, the "resect and discard" strategy demonstrates both excellent feasibility and safety, and the follow-up period is 99.59% consistent with the guidelines. Furthermore, the scope of this strategy can be safely expanded for patients undergoing polypectomy during postresection surveillance.