SUCCESSFULLY PREDICTING RECURRENCE OF COLORECTAL POLYPS AT RESECTION- A UK TERTIARY REFERRAL CENTRE EXPERIENCE

Aims:

To identify colorectal polyp features during a complex EMR which could be associated with its recurrence.

Methods:

A retrospective study looking at patients who underwent EMR for complex colorectal lesions from a period of January 2007 to July 2018. It included patients referred to a single endoscopist primarily due to the complexity of the polyp (SMSA level 3 or 4) who underwent a colorectal EMR. It excluded patients undergoing an ESD with an en bloc resection. Data was collected through the online endoscopy reporting system and pathology reporting system. Events like scarring, size and morphology were documented in the endoscopy report at the time of resection. Recurrence was noted on follow up endoscopies at 3 – 6 months, one year and other subsequent endoscopies.

Results:

Total no of polyps resected: 668.

Total cases of recurrences: 90 (13.7%).

Tab. 1

	Recurrence (n = 90)	No Recurrence (578)	p-value
Scarring (n = 95)	20 (22.2%)	75 (13%)	0.04
Mean size (mm)	59.6	39.7	0.006
Accesibility	70 (77.8%)	439 (75.9%)	0.88
Morphology- Flat	49 (54.4%)	293 (50.7%)	0.7
Morphology- Sessile	39 (43.3%)	223 (38.6%)	0.57
Morphology- Pedunculated	2 (2.3%)	62 (10.7%)	0.03
Site- Rectum	51 (56.7%)	150 (26%)	< 0.001
Site- Colon	39 (43.3%)	428 (74%)	0.008

Conclusions:

This study provides crucial evidence in determining factors that could predict recurrence in patients with complex colorectal polyps. It shows that larger polyps and rectal polyps have higher recurrence and interestingly also proves scarring of a polyp may be an important factor in its recurrence. We also noted that scarred polyps had a higher rate of recurrence than non scarred polyps (21% and 12%).

This study may help us to develop a scoring system to predict recurrence.