ASGE technology committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps

Barham K. Abu Dayyeh, Nirav Thosani, Vani Konda, Michael B. Wallace, Douglas Rex, Shailendra S. Chauhan, Joo Ha Hwang, Sri Komanduri, Michael Manfredi, John T. Maple, Faris M. Murad, Uzma D. Siddiqui, Subhas Banerjee

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

In vivo real-time assessment of the histology of diminutive (≤ 5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I2 statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave " strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I2 Z 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence. (Gastrointest Endosc 2015;81:502-16.)

Original languageEnglish
Pages (from-to)502-516
Number of pages15
JournalGastrointestinal Endoscopy
Volume81
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Gastrointestinal Endoscopy
Advisory Committees
Polyps
Narrow Band Imaging
Meta-Analysis
Histology
Technology
Biopsy
Confidence Intervals
Adenomatous Polyps
Biomedical Technology Assessment
Colonoscopy
Colon
Color

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

ASGE technology committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. / Abu Dayyeh, Barham K.; Thosani, Nirav; Konda, Vani; Wallace, Michael B.; Rex, Douglas; Chauhan, Shailendra S.; Hwang, Joo Ha; Komanduri, Sri; Manfredi, Michael; Maple, John T.; Murad, Faris M.; Siddiqui, Uzma D.; Banerjee, Subhas.

In: Gastrointestinal Endoscopy, Vol. 81, No. 3, 01.03.2015, p. 502-516.

Research output: Contribution to journalArticle

Abu Dayyeh, BK, Thosani, N, Konda, V, Wallace, MB, Rex, D, Chauhan, SS, Hwang, JH, Komanduri, S, Manfredi, M, Maple, JT, Murad, FM, Siddiqui, UD & Banerjee, S 2015, 'ASGE technology committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps', Gastrointestinal Endoscopy, vol. 81, no. 3, pp. 502-516. https://doi.org/10.1016/j.gie.2014.12.022
Abu Dayyeh, Barham K. ; Thosani, Nirav ; Konda, Vani ; Wallace, Michael B. ; Rex, Douglas ; Chauhan, Shailendra S. ; Hwang, Joo Ha ; Komanduri, Sri ; Manfredi, Michael ; Maple, John T. ; Murad, Faris M. ; Siddiqui, Uzma D. ; Banerjee, Subhas. / ASGE technology committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps. In: Gastrointestinal Endoscopy. 2015 ; Vol. 81, No. 3. pp. 502-516.
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AU - Thosani, Nirav

AU - Konda, Vani

AU - Wallace, Michael B.

AU - Rex, Douglas

AU - Chauhan, Shailendra S.

AU - Hwang, Joo Ha

AU - Komanduri, Sri

AU - Manfredi, Michael

AU - Maple, John T.

AU - Murad, Faris M.

AU - Siddiqui, Uzma D.

AU - Banerjee, Subhas

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N2 - In vivo real-time assessment of the histology of diminutive (≤ 5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I2 statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave " strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I2 Z 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence. (Gastrointest Endosc 2015;81:502-16.)

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