Trends in Lower Gastrointestinal Endoscopic polypectomy and endoscopic mucosal resection: a National cross-sectional e-survey

Aims Endoscopic polypectomy and endoscopic mucosal resection (EMR) are widely used techniques, largely due to their increasing number of screening colonoscopies. Recently, the ESGE provided a core curriculum for training in EMR [1]. Among the recommendations for Hot-EMR, it is suggested that the endoscopist personally takes over the snare from the assistant and closes it to gain a better perception of the grasped tissue, thereby reducing risks. However, data regarding endoscopist preferences and common practices in lower gastrointestinal (GI) polypectomy are lacking. This study aims to elucidate the current practices and preferences of young Italian endoscopists (age<40 years).

Methods A national cross-sectional e-survey was conducted in Italy between June and August 2024. Participants were recruited from the Young Endoscopist Polypectomy study group (PolYoung). The e-survey included questions regarding demographics, volume of procedures,perceived proficiency levels, and technical preferences in endoscopic polypectomy. Descriptive and inferential statistical analyses were performed to identify trends and disparities based on demographic and experience characteristics.

Results A total of 71 GI endoscopists (M 46:F 25, 0 non-binary) responded to the e-survey. Nearly half (52.1%) were aged 30-35years. Among the participants, 52.1% worked in university hospitals, while 43.7% worked in non-university community hospitals and 4.2% in private hospitals.49.3% of participants had performed more than 1,000 colonoscopies as the first operator.Additionally, 66.2% had performed more than 100 cold snare polypectomies, and almost all participants (98.6%) felt confident performing this procedure independently. Regarding Hot-EMR, 43.7% had performed more than 50 procedures, and 66.2% felt independent in performing this technique. When asked about their preferences for Hot-EMR, 93% of the participants preferred to instruct the assistant to open the snare to grab the polyp and then cut the lesion themselves, rather than taking over the snare to cut the polyp, in order to maintain control of the scope.Only 15.5% of participants routinely added adrenaline to the injection solution. However, 58.6% of participants routinely performed prophylactic closure of the post-resection scar in all large (> 20 mm) EMRs of the proximal colon, while 22.9% did so for all EMR lesions, regardless of size, when patients were on antithrombotic drugs. Regarding novel EMR techniques, 70.4% and 80.3% ofparticipants had performed underwater-EMR and cold-EMR, respectively. Finally, no statistically significant differences were observed between demographic factors, years of experience, and proficiency levels for any of the variables considered.

Conclusions This study provides valuable insights into the common practices of endoscopic polipectomy in the italian young endoscopists scenario. Notably, a low adherence to the ESGE-recommended Hot-EMR technique was observed. Therefore,this finding highlights the need for further comparative studies between different approaches.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Tate D.J.. et al. “Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement,” Endoscopy. 55 no. 7 pp645-679Jul.