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PWE-008 The East Midlands polypectomy study
  1. S DIN1,
  2. K Kerr2,
  3. A Goddard2
  1. 1Department of Gastroenterology, Chesterfield Royal Hospital, Chesterfield, UK
  2. 2Department of Gastroenterology, Royal Derby Hospital, Derby, UK

Abstract

Introduction The NHS Bowel Cancer Screening Programme was introduced in 2006 for the early detection of cancer and premalignant polyps. This has resulted in a large number of polyps being found on colonoscopy and an opportunity to accumulate good data and risk stratify polypectomy complication rates. The Munich polpypectomy study was a large, prospective, multicentre study of 4000 snare polypectomies in 2257 patients. Complications occurred in 9.7% of patients (6.1% polyps) with 7.0% of these complications being minor and 2.7% major. Polyp size was identified as an important risk factor for major complications, followed by right sided location and number of polyps. However, there is a lack of large systematic prospective studies in the UK of polypectomy complications.

Methods Data on all polypectomies at two DGHs were collected prospectively over 24 months as part of the normal bowel screening process. Early and late complications were recorded. The service review included patients enrolled onto the screening programme between the ages of 60–69 and who had a polypectomy. Patients were excluded if they were <60 or >70 years old and not had a polypectomy. The primary endpoints of the study were polypectomy complications which were classed as major or minor. The risk factors for complications were analysed for patient demographics, polyp size, distribution and histology.

Result 1388 patients participated in the bowel screening programme and 780 patients were identified (535 male and 245 female) with a total of 2098 polypectomies. 45% of the patients had left sided polyps, 13.3% right and the remainder of polyps on both sides. 70% of polyps were <5 mm, 19.8% 5–10 mm, 12.7% 10–20 mm and 7.2% >20 mm. The total complication rate was 1.79% (95% CI 0.86 to 2.72) with a polyp complication rate of 0.67% and zero mortality. There were three (0.38%) major complications (95% CI −0.05 to 0.81); 1 left sided perforation requiring surgery, one right sided perforation which was clipped and one major bleed. Left sided polyp location was a risk factor for minor bleeding complications 1.41% (95% CI 0.58–2.24). Cancerous polyps (3/14) and polyp size 5–10 mm carried an increased risk of complications.

Conclusion The bowel screening programme has added another dimension due to the large volume of polyps being found and polypectomies undertaken. This study has shown that serious complications are rare. Identification of patient and polyp characteristics can be used as a predictor to reduce the incidence of major complications; however, a larger study is needed to clarify this.

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