David Lieberman, Joel Brill, Marcia Canto, Daniel DeMarco, Brian Fennerty, Neil Gupta, Loren Laine, Charles Lightdale, Elizabeth Montgomery, Robert Odze, Douglas Rex, Prateek Sharma, Michael Kochman, Jeffrey Tokar

Diminutive colon polyps, defined as less than or equal to 5mm, are increasingly encountered at colonoscopy. The risk of serious pathology in such polyps is low. There is a risk and cost of resecting all such polyps and sending tissue for pathologic evaluation. Enhancement of endoluminal imaging may enable discrimination of neoplastic versus non-neoplastic polyps. If this discrimination can be performed accurately with high confidence, it may be possible to either resect and discard diminutive adenomas, or inspect and do-not-resect diminutive hyperplastic polyps. In 2011, an expert group recommended thresholds of 90% negative predictive value for adenoma, and 90% accuracy in predicting appropriate surveillance interval. Since 2011, criteria for polyp discrimination have been published and validated by experts and non-expects. In-vivo studies have been performed to compare endoscopic impression and pathologic diagnosis. An expert panel was convened in late 2014 to review the literature to determine if proposed thresholds for discrimination can be attained and recommend the next steps for introducing changes in clinical practice. The review concludes that threshold levels can be achieved with several endoscopic image enhancements. Next steps to implementation of practice change include acquiring data on training and competence, determining best practices for auditing performance, understanding patient education needs, and the potential cost-benefit of such changes.