内窥镜技术的进步，如窄带成像和高清结肠镜，为细小（≤5毫米）和小（6-9毫米）结肠息肉的光学诊断（OD）提供了潜力，采用“切除和丢弃”（RD）策略。这可能有助于减轻组织病理学所需的巨大费用和时间负担。本研究旨在对英国结肠癌筛查计划（BCSP）中的RD策略进行经济分析。设计了一棵决策树，将RD策略与标准组织病理学进行比较，用于DISCARD3研究中的患者，并推广到全国BCSP患者队列中。在DISCARD3研究中的525名患者中，排除了患有结肠癌和至少一个> 10毫米息肉的病例，评估了354个患者的监测间隔时间。 在269/354个病例中有息肉，其中182个只有细小的息肉，77个既有小的又有细小的息肉，10个只有小的息肉。 对于至少有1个细小息肉的患者，监测间隔时间的一致性为97.9％，对于至少有1个细小或小息肉的患者，监测间隔时间的一致性为98.7％。在DISCARD3中，采用RD方法，可以为患有细小息肉的患者减少总体直接医疗费用35,468.8英镑（-72.3％），或为患有细小或小息肉的患者减少总体直接医疗费用42,666.2英镑（-75.0％）。当推广到整个英国BCSP时，在调整OD质量保证过程（QAP）成本后，一年的节省金额几乎为2.4m英镑的细小息肉或3.4m英镑对于细小或小息肉的患者。在不损害监测间隔一致性的情况下，利用BCSP结肠镜检查进行细小和小息肉的OD和RD策略将提供大量成本节约。版权所有©2023年美国胃肠内镜学会。由Elsevier Inc.出版。保留所有权利。

Advances in endoscopic technology, such as narrow band imaging and high definition colonoscopes, offer the potential for optical diagnosis (OD) with a "resect and discard" (RD) strategy for diminutive (≤5mm) and small (6-9mm) colorectal polyps. This could help alleviate the huge cost and time burden required for histopathology. The aim of this study is to conduct an economic analysis of a RD strategy within the English Bowel Cancer Screening Programme (BCSP).A decision tree was designed to compare a RD strategy with standard histopathology for patients included in the DISCARD3 study and was extrapolated to a national BCSP patient cohort.Of the 525 patients in the DISCARD3 study, 354 were assessed for surveillance intervals (after excluding cases with colorectal cancer and at least one polyp >10 mm). 269/354 cases had polyps of which, 182 had only diminutive polyps, 77 had both small and diminutive polyps, and 10 had only small polyps. Surveillance interval concordance was 97.9% in patients with at least 1 diminutive polyp and 98.7% in patients with at least 1 diminutive or small polyp. In DISCARD3, a RD approach would reduce overall direct healthcare costs by £35,468.8 (-72.3%) for patients with diminutive polyps or by £42,666.2 (-75.0%) for patients with diminutive or small polyps. When extrapolated to the entire English BCSP, the annual savings are almost £2.4m for patients with diminutive polyps or £3.4m for patients with diminutive or small polyps, after adjusting for the costs of an OD quality assurance process (QAP).OD with a RD strategy for diminutive and small polyps during BCSP colonoscopy would offer substantial cost savings without adversly affecting surveillance interval concordance.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.