Introduction Advances in endoscopy training and endoscopic resection techniques have facilitated the development of advanced EMR service in few regional centres. This should equate to a reduction in the number of surgery for benign colorectal polyps. Interestingly, a previous study of hospital episode statistics database for national trends in benign colorectal polyp surgery had showed no significant difference in the reduction of surgery over a 10 year period.1We aimed to assess the impact of a new advanced EMR service on the need for surgical intervention for benign polyps in a tertiary care centre.
Method The advanced EMR service (including level 3 and 4 polyps)2was set up in May 2013. We retrospectively looked at the MDT outcomes 20 months prior and after setting up of the service to identify patients requiring external referral or surgery for benign polyps. Hospital electronic records were reviewed to ascertain details concerning polyp size, complications and bed days.
Results In the period before the EMR service, 51 patients underwent surgery for benign polyps requiring 285 bed days. 8 complications were encountered. The average polyp size was 3.2 cms (Range 1–8 cms). 6 patients were referred externally for advanced EMR. Between May 2013 and Dec 2014, since the setting up of the service, 8 patients have had surgery requiring 46 bed days. During the same time, 180 polyps were encountered in 168 patients. The mean polyp size varied from 1.5 cms to 12 cms. Excluding patients who had surgery for invasive cancer, 91% of patients avoided surgery. Of 139 completely resected benign polyps, 66 (47%) polyps were level 4 and 89% polyps achieved complete endoscopic clearance with one procedure. 4 complications required 9 bed days.
Conclusion An advanced EMR service decreases the need for surgical intervention, reduces the number of bed days and complications. Moreover, such a service also offers important savings for local healthcare economies. This study also emphasise the need for the development of regional benign polyp MDT.
Disclosure of interest None Declared.
Almoudaris AM, et al. Surgery for benign colorectal polyps in England – trends and outcomes from 1997 to 2007. Gut 2011;60:A4
Gupta S, et al. The “SMSA” scoring system for determining the complexity of a polyp. Gut 2011;60:A129