PWE-005 Management of High Risk Colonic Polyps

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Abstract

Introduction

Colorectal cancer is a significant health problem, the importance of which will increase substantially in the coming years. Demand for colonoscopy will increase and so will demand for complex polypectomy to deliver a reduction in incident rates.

Methods

Colonoscopy reports with an endoscopic diagnosis “high risk colonic polyp” were examined over a 6 month period. Histology was reviewed to determine the precise histological classification of all polyps. Repeat procedures over the following 2 years were reviewed for completeness of initial resection. Complete adenoma clearance rates were calculated based on observation of residual polyps or residual polyp tissue at previous polypectomy site.

Results

Twenty one colonoscopists performed 2139 colonoscopies. The median caecal intubation rate was 93%. The number of procedures performed by individual endoscopists varied between 14–464. The median was 64 procedures. In 564 (24%) cases, one or more than one polyp were identified. Individual endoscopist adenoma detection rates (ADR) did vary. The median ADR was 24% (0–44%). In 79 cases the endoscopic diagnosis was reported as “high risk”. When the initial reports were analysed with histology, 52 (69 %) cases met BSG high-risk criteria. Of the 52 high-risk polyp cases, histology confirmed adenocarcinoma in 10 cases. Surgery was performed for 5 benign cases. Of the 44 benign lesions managed endoscopically, 35 (80%) patients were recommended to undergo a repeat procedure (s). In total 24 patients underwent one repeat procedure, 8 underwent 2 repeat procedures and 3 patients underwent 3 repeat procedures over the follow up period.

Results

Complete adenoma clearance rate at index endoscopy in this audit was achieved in 11 (31%) cases. Two further cases were regarded as having complete clearance following a subsequent resection.

Conclusion

The finding of multiple or complex polyps puts pressure on colonoscopists. Difficult procedures may adversely affect ADR. Although key performance indicators such as caecal intubation rate have improved with national training programmes, this audit and other studies have demonstrated variation in therapeutic outcomes.1 Scoring systems for complex polypectomy should be employed to encourage endoscopists to defer polypectomy in some situations.2 Designated therapeutic lists will benefit patients and endoscopy units with reduction in repeated procedures and improved mentoring/training opportunities in complex polypectomy.

Disclosure of Interest

None Declared.

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