Introduction Endoscopic Mucosal Resection (EMR) has been developed for minimally invasive endoscopic removal of large benign and early malignant lesions. Before carrying out colorectal EMR, it is important to characterise the lesion for removal distinguishing between adenoma and adenocarcinoma and the marginal demarcation of the lesion. There are a number of tools an endoscopist can use to characterise a lesion such as observation (e.g. lesion colour, presence of depression and use of the Paris classification) as well as more advanced techniques such as chromo-endoscopic observation (using Kudo classification) and then check for non-lifting sign in presumed colorectal cancers
Methods A single centre, retrospective analysis in a large London NHS Foundation Hospital was performed. All patients undergoing EMR were identified using Unisoft Endoscopy reporting software across a period of 12 months (Jan 2015-Jan2016). Data was collected regarding the referral, EMR procedure and the patients’ histological diagnosis.
Results 32 patients were referred and underwent EMR with colorectal lesions greater then 2 cm in size. 23 lesions were accurately described in terms of size. 17 lesions were only described in terms of polyp, with no further distinguishing features. Only 9 of the lesions were commented on with regards to Pitt pattern or Paris classification. 3 lesions were identified as cancerous at the time of endoscopy with only one checked for lift sign. 13 lesions were biopsied, prior to EMR. 6 lesions were rectal and only 8 out of the remaining lesions were tattooed. In referral of the lesions 7 had specified the number of units required for the EMR procedure, 3 were referred for MDT discussion the rest had no further details.
Conclusion Our case series shows a wide variation in practice in regards to lesion description which can have detrimental effects on patient care. A large number of polyps referrals to EMR are not clearly described in terms of Paris or Kudo classification and the absence of the non-lifting sign. The planning of EMR could be made easier if the pre-EMR assessment included size of the lesion, and clear description with regards to pit pattern and Paris classification. In addition allowing adequate time can be difficulty without a clear lesion description. Regular auditing and presentation go some way to improving practice in a department but endoscopists can come from different departments, be locums or endoscopy can be out sourced. Our opinion would be to ensure that cues are placed in the reporting software to enable accurate assessment and management of lesion considered for EMR as an alternative to EMR endoscopist having to repeat the colonoscopy to assess the lesion prior to scheduling the EMR with appropriate length of time to perform to the procedure.
Disclosure of Interest None Declared