Original articleClinical endoscopyDiminutive polyps among black and Latino populations undergoing screening colonoscopy: evidence supporting a resect and discard approach

BackgroundA resect and discard strategy for diminutive (≤5 mm) colon polyps has been proposed to save costs of screening colonoscopy (SC). Prior studies on neoplasia prevalence based on polyp size have involved mostly white patients.ObjectiveTo determine the prevalence of adenomas and advanced histologic features by size among primarily black and Latino patients enrolled in a prospective SC study.DesignRetrospective analysis of data from a prospective clinical trial.SettingUrban academic medical center.PatientsAverage risk, asymptomatic, minority patients aged ≥50 years undergoing SC.InterventionsScreening colonoscopy.Main Outcome MeasurementsRates of neoplasia and advanced histologic features (villous histology, high-grade dysplasia, or cancer) by polyp size and location.ResultsA total of 566 polyps from 295 patients were analyzed. Diminutive polyps and small (6-9 mm) polyps had lower prevalence of ≥1 advanced feature compared with large (≥10 mm) polyps (0.9% and 2.7%, respectively, vs 13.6%; P < .001 for both comparisons). Distal polyps were less likely to be neoplastic (31.7% vs 61.4%; P < .001) than proximal polyps in all size categories (P < .001 for all comparisons). After adjusting for sex, ethnicity, age, and location, large polyps were more likely to have ≥1 advanced feature than diminutive polyps (adjusted odds ratio [OR] 19.5; 95% CI, 4.4-85.6) or small polyps (adjusted OR 6.1; 95% CI, 2.2-16.9).LimitationsUse of pathology reports for polyp size.ConclusionAmong a cohort of minority patients, advanced histologic features were very rare in diminutive polyps. Distal polyps were less likely to be neoplastic than proximal polyps in all size categories. This supports a resect and discard strategy for diminutive polyps, especially in the distal colon.