Health Research and Policy

Research in Progress Seminar (RIP)

Date: May 1, 2013
Time: 1:30 pm - 3:00 pm
Location: Medical School Office Building, Rm x303
Speakers: Sarah McGill, MD
Title: Can Optical Diagnosis of Colon Polyps Make Colonoscopy Safer, Less Costly and More Efficient?: A Systematic Review, Meta-Analysis and Cost-Effective Analysis


Colon cancer is the second leading cause of cancer death in the United States, and screening with colonoscopy is recommended for all Americans starting at age 50. Colonoscopy is resource intensive, and reimbursed at an estimated cost of ~$3,000 by private insurers.

Most polyps are small (<1cm.) and these small polyps are overwhelmingly non-malignant. About half of polyps are hyperplastic, which do not have malignant potential. In the current standard of care, all polyps are resected at colonoscopy and sent to pathology, where their pathologic diagnosis (neoplastic versus hyperplastic) is determined. This represents a large cost burden. The differentiation between neoplastic versus hyperplastic polyp is important as it influences the surveillance intervals to next colonoscopy.

Advances in endoscopic imaging such as Narrow Band Imaging, a light filter that makes neoplastic polyps appear darker, have allowed for endoscopists to better distinguish hyperplastic and neoplastic polyps in real time, at the moment of detection. In theory, if the pathology of small polyps could be identified optically in real time with high confidence, they could be either resected and discarded (in the case of adenomas) or left in the colon without resection (in the case of recto-sigmoid hyperplastic polyps), leading to cost savings in accessory and pathology fees.

Our first aim was to perform a systematic review and meta-analysis of the available literature to determine the sensitivity and specificity of optical diagnosis of colon polyps using Narrow Band Imaging.

Our second aim was to perform a cost-effectiveness analysis to evaluate the long-term economic and health consequences of a strategy of optical diagnosis of small polyps versus the standard of care.

Please note: All research in progress seminars are off-the-record. Any information about methodology/press release and/or results are embargoed until publication.
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