Can we do resect and discard with artificial intelligence-assisted colon polyp “optical biopsy?”

Abstract

Resect and discard refers to a paradigm for the management of colorectal adenomas 1-5 mm in size. In this paradigm, histology of colorectal polyps is predicted endoscopically based on surface features. Lesions that are ≤5 mm in size and predicted to be adenomas are resected endoscopically and discarded rather than submitted to pathology. Adenomas in this size range have an extremely low risk of cancer, and the cost savings of the resect and discard paradigm would be substantial. Artificial intelligence programs can improve the overall prediction for histology based on endoscopic imaging, and reduce operator dependence in endoscopic predictions. Although meta-analyses have concluded that the accuracy of endoscopic prediction is sufficiently high to institute the resect and discard paradigm in clinical practice, actual implementation has faced several obstacles. These include lack of financial incentives for endoscopists, perceived increased medical-legal risk compared with the current management paradigm of submitting all polyps to pathology, and local rules for tissue handling.