LARGE NON-PEDUNCULATED COLORECTAL POLYPS/COMPLEX POLYPS MDT ORGANISATION AND PRACTICE ACROSS YORKSHIRE REGION, UK

Aims The British Society of Gastroenterology published guidance on the management of large non-pedunculated polyps in 2015. The aim of this survey was to assess the organisation and practice of complex polyps MDT across the Yorkshire region, UK.

Methods An electronic survey was created on Survey Monkey. All 13 Yorkshire hospitals, who manages complex polyps, were approached and lead consultants asked to complete the electronic survey with remainders sent at monthly intervals. The data was collected from March-August 2019.

Results 10/13 centres responded. Six centres (including all three tertiary centres) run formal stand-alone complex polyp MDT, three centres discuss complex polyps as part of colorectal cancer MDT and one centre refers all cases directly to an internal expert. Four of the meetings were held on weekly bases and the rest fortnightly.

For the stand-alone MDTs, advance endoscopists are present in all MDTs, colorectal surgeons participate in five, pathologists and booking staff are present in three MDTs and radiologists only in two.

In only 6/10 centres do the staff have dedicated time allocated for the meetings.

Six centres have set criteria for referrals and use the SMSA scoring system. The median number of cases discussed per meeting is 4.5 (range 3-20). Six centres “always or usually” have high quality videos or photos of polyps available for MDT review. Four centres receive external referrals to their MDTs (two tertiary & two district hospitals).

Only 50% of centres specifically audit key performance indicators for their advanced endoscopists and only 60% of centres issue patients with written information about the proposed risks and benefits before attending.

Conclusions There is a considerable variation in large and complex polyp MDT practice across Yorkshire Hospitals. All tertiary centres run stand-alone specialised MDTs but dedicated time and infrastructure support is limiting the development of this important service in many centres.