MANAGEMENT OF LARGE COLORECTAL POLYPS AT AN ELECTIVE ENDOSCOPY SITE – OUTCOMES FROM A DEDICATED POLYP MULTIDISCIPLINARY MEETING

Aims The British Society of Gastroenterology (BSG) guidelines provide a framework for the management of large (> 2 cm) non-pedunculated colorectal polyps (LNPCPs). This includes a recommendation to have access to a polyp multidisciplinary meeting (MDM). We aimed to evaluate patients diagnosed with large colorectal polyps at an elective (´cold´) endoscopy unit.

Methods Single centre retrospective study at an elective London-based hospital, serving a population of 500 000, during a two-year period (January 2017 – December 2018). Complexity was assessed by the SMSA score.

Results 97 patients with colorectal polyps > 2 cm identified. Median age 71 years (IQR 61–78), Male 52/97 (54%).

Most polyps were non-pedunculated (LNPCPs) [69/97 (71%)]. Median size and SMSA score 30 mm (IQR 25–40) and 3 (IQR 3–4), respectively. Commonest sites were sigmoid colon [23/97 (24%)], ascending colon [18/97 (19%)], caecum [17/97 (19%)] and rectum [14/97 (14%)].

The majority of polyps were discussed at polyp MDM, 65/97 (67%). 43/65 (66%) were referred for endoscopic mucosal resection (EMR), 11/65 (17%) surgical resection [8/11 (73%) adenocarcinoma], 4/65 (6%) for endoscopic submucosal dissection (ESD) and 4/65 (6%) deemed not fit for polypectomy.

75/97 (77%) underwent EMR; 32/75 (43%) en-bloc. Most EMRs were by specialist endoscopists [62/75 (83%)]. Sedation used in 68/75 (91%) cases with age appropriate doses of fentanyl and midazolam. All polyps were retrieved and all patients had a follow up management plan documented post procedure. Post polypectomy bleeding (PPB) occurred in 2/75 (3%) patients. The 30-day mortality and perforation rates were zero.

Conclusions Over seventy percent of large polyps detected were LNPCPs and two-thirds of large polyps were discussed in a dedicated polyp MDM. This enabled informed consensus decision making with appropriate triage to endoscopic resection by a specialist endoscopist, surgery or conservative management. We conclude that large polyp resections can safely be undertaken by experienced endoscopists in a structured elective setting.