POLYPECTOMY IN SCREENING COLONOSCOPIES – ARE WE FOLLOWING THE PUBLICATION OR THE GUIDELINES?

Aims:

The European Society of Gastrointestinal Endoscopy (ESGE) guidelines for colorectal polypectomy recommends cold snare polypectomy for all diminutive (≤5 mm) and small polyps between 6 – 10 mm. In a publication from Britto-Arias the forceps resection rates (FRR) for polyps ≥5 mm were 22,75% in hospitals and 52,58% in private practices. The aim of this study was to compare if the publication of own results or publication of the guidelines has more impact on the reduction of FRRs of polyps ≥5 mm.

Methods:

107.124 colonoscopies performed by 279 endoscopists between 08/2015 and 10/2018 were assessed within the Austrian quality assurance program for screening colonoscopies. For the demonstration of the endoscopists adherence to the European polypectomy guidelines, the resection technique, based on the polyp size before (08/2015 – 03/2017) and after (04/2017 – 10/2018) the publication of the guidelines was assessed and compared. Further we investigated if there was a decrease of the FRR after our prior study by Britto-Arias et al. (08/2015). Therefore, endoscopists were subclassified according to their facility (hospital, private practice).

Results:

A total of 90.279 screening colonoscopies performed by 266 endoscopists were included in this study. The polyp detection and resection rate were 38,58% (n = 34.826) and 91,74% (n = 31.948), respectively. Overall, 28,00% (n = 2.521) of polyps ≥5 mm were resected using forceps, which does not correspond to the ESGE-Guidelines. For polyps ≥5 mm the FRR decreased in private practices after both publications (RR:0,68vs.0,83; p < 0,001). In contrast, in hospitals a significant decrease of the FRR was observed after the study but not after the guideline's publication (RR:0,91vs.1,19; p < 0,001). At least, for polyps ≥5 mm endoscopists had a mean adequate polypectomy technique rate of 68,31% (CI95%: 64,21 – 72,41).

Conclusions:

Regarding to the polypectomy technique, we have investigated that the study publication leads to an increase of the adherence for polyps ≥5 mm in both, hospitals and private practices.