ESTIMATING DIFFICULTY OF ENDOSCOPIC RESECTION WITH SMSA POLYP COMPLEXITY CLASSIFICATION SYSTEM

Aims:

SMSA classification system consists of four factors (size, morphology, site, access) from which it identifies four different levels of polyp complexity (L1-L4).

The aim of this study was to validate SMSA classification system.

Methods:

This prospective, cohort study was conducted at two general hospitals and one high volume center in Croatia. All polyps which were classified with SMSA classification system and removed during the procedure were included in this study.

Results:

From 336 resected polyps, most of them were in L1 (38%) and L2 (52%), 10% of removed polyps were in L3 an L4. 100% of polyps in L4 and 86% of polyps in L3 were resected in a high volume center. Biopsy forceps (34%) and hot snare (30%) were most often used techniques for L1 and L2, and EMR (94%) was used in more difficult levels. Average time necessary to remove polyps in L1 and L2 was 2,7 min and in L3 and L4 it was 36 min. 100% of L1 and L2 polyps and 94% of L3 and L4 polyps were removed in the first act. The complication rate was significantly higher in higher levels of classification scale (in L1 and L2 it was 0% vs. 6% in L3 and 13% in L4).

Conclusions:

The SMSA classification system is easy to use and it provides us with coherent information about polyp complexity to help us better plan time, techniques and skills necessary for endoscopic procedures depending on the level of polyp complexity and helps us to predict outcomes.