Evaluation of Completeness of Referrals for Large Non-Pedunculated Polyps in Accordance with International Consensus Guidelines

Aims Endoscopic mucosal resection (EMR) is standard-of-care for treating large non-pedunculated colorectal polyps yet often requires referral to expert centers. Hence, inclusion of important information to the therapeutic endoscopist is essential for pre-procedure planning. A recent international consensus statement, comprised of 19 components, aims to improve triage and planning of endoscopic resection for large non-pedunculated colorectal polyps. We sought to determine the current status of inclusion of these reporting elements in referrals to our tertiary center.

Aims 1- Report the rate of complete referrals in light of the international expert consensus statement. 2- Investigate the degree of correlation of polyp adjudication between referring endoscopist and local advance therapeutic endoscopiest assessment. 3- Explore factors predicting comprehensive reporting.

Methods Single-center review of prospectively collected colorectal polyp referrals for large non-pedunculated polyps from March 2021 to March 2023.

Results 411 referrals for large polyps were received; median size 3 cm; 58% located in ascending colon. 89% of referrals included the initial assessment date, and only 38% incorporated video or photo documentation, of which 44% were deemed sufficient to demonstrate polyp features. Anatomical location was reported in 96% of referrals, while polyp size was mentioned in only half of the referrals (50%). Polyp morphology was described in 91% as either sessile (n=360) or pedunculated (n=35). Paris classification was reported in 53% of referrals, and LST classification in 90%. 12% of referrals reported four elements of less, while 18% of referrals reported all elements. Correlations with our own endoscopic assessments were diverse, ranging from a robust correlation for anatomical location (r=0.82, 95%CI 0.78-0.86, p<0.001) to a more modest correlation for Paris classification (r=0.44, 95%CI 0.35-0.52 p<0.001).

Conclusions Our study reveals deficiencies in current referral practices and emphasizes the international consensus statement's role in improving the process. Consequences of low-quality referrals may include compromised patient care, leading to delayed diagnoses, inappropriate treatments, and potentially compromised patient outcomes. Thus, we have identified a likely knowledge gap in polyp characterization among referring physicians that will be a focus of a subsequent QI initiative on a provincial, national and international level.

Publication History

Article published online:
27 March 2025