Patient acceptance of the optical diagnosis and misdiagnosis of diminutive colorectal polyps

Background and Aims Optical diagnosis allows for real-time endoscopic assessment of colorectal polyp histology and consists of the resect and discard and diagnose and leave paradigms. This survey assessed patient acceptance of optical diagnosis and their responses to a hypothetical doomsday scenario. Methods We conducted a 3-month cross-sectional survey of colonoscopy outpatients presenting to an Australian academic endoscopy center. Results A total of 981 patients completed the survey (76.0% response rate). The 60.8% of patients who supported resect and discard were more likely to be older men who co-supported diagnose and leave. Fewer patients (49.6%) supported diagnose and leave. A family history of missed cancer diagnosis (odds ratio [OR], 0.59; P  = .003) was significantly associated with rejection of resect and discard, and a personal or family history of bowel cancer (OR, 0.7; P  = .04) was significantly associated with rejection of diagnose and leave. In the hypothetical scenario of a cancerous polyp incorrectly left in situ leading to stage III disease, 208 (21.2%) patients would definitely ask for financial compensation, 584 (59.5%) were unsure, and 189 (19.3%) would definitely not seek compensation. The patient-proposed median value of compensation sought was $760,000 USD ($1,000,000 AUD; $1 AUD=$0.76 USD). Notably, 18.5% would be willing to give optical diagnosis another chance after this error. Conclusion Patient support for optical diagnosis is limited, and those who are not supporters are more likely to seek financial compensation if errors occur.