Specialist pre-operative clinics are an established part of cancer care. Limited or no data is available on the impact of specialist clinic for complex colo rectal polyps. Our tertiary referral centre is experiencing increasing numbers of elderly, co-morbid patients with benign complex polyps. Optimising a successful, appropriate and safe management strategy is fundamental to offering a quality service.Objective
The purpose of this pilot prospective study was to assess the impact of a specialist complex polyp clinic on the resulting management strategies and and outcomes for patients.Methodology
A monthly specialist complex polyp clinic was established in January 2016. If indicated, endoscopic polyp assessment was performed on the same day. Inclusion criteria was defined as complex, large polyps in a patient with multiple co-morbidities. Patient demographics, polyp data and outcome were retrieved from the complex polyp clinic database.Results
A total of 64 patients attended the complex polyp clinic between January 2016 and December 2017. Most cases discussed were tertiary referrals (88%). Median age of our cohort was 74 years. Median size of the polyp was 20 mm (mean 31, SD 30 mm). Most of the polyps were in colorectum (92.2%), and the remainder were in the upper GI tract. Main reasons for a review in the clinic were: discussion of therapeutic options (surgery vs endo therapy) and the risks/benefits of therapy 80%, discussion of surveillance 25%, discussion of previous endoscopic results 16%. A quarter of the patients who attended the clinic had a polyp assessment on the same day. 58% of patients underwent nurse led pre-assessment during the clinic visit.Results
Following the clinic discussion and polyp assessment 47% (30/64) of patients had a successful endoscopic resection of polyps, 12.5% (8/64) had laparoscopic surgical resection, 30% (19/64) were recommended for surveillance colonoscopy or CT colonography, 6% ( 4/64) declined to have proposed therapy,1.5% (1/64) of cases no therapy was recommended,1.5% (1/64)awaiting to have a combined laparo endoscopic therapy and 1/64 (1.5%) patient passed away due to ischaemic heart disease before their proposed treatment.Conclusions
The complex polyp clinic provides an opportunity to discuss the therapeutic options in the management of complex benign polyps and to assess the fitness of the individual for proposed therapy. Furthermore, a comprehensive endoscopic polyp assessment could be carried out during the clinic visit to plan appropriate therapy.