Introduction Data from the UK Bowel Cancer Screening Programme (BCSP) has established that the assessment and management of large non pedunculated colorectal polyps (LNPCPs) varies markedly, leading to variable and often suboptimal outcomes, especially for the most complex lesions1. A multicentre complex polyp multidisciplinary team meeting was created within the North East of England BCSP with the aim of ensuring more robust decision making and management of complex LNPCPs.
Method A virtual multicentre MDM was conducted via audioteleconferencing within the North East of England between 2014–6 to discuss complex LNPCPs (LNPCPs with increased risk of malignancy or complexity associated with endotherapy, as defined in BSG/ACPGBI guidelines2). Non-complex LNPCPs were not discussed. Patient data was distributed securely via NHSmail. Outcomes were assessed prospectively using key performance indicators (KPIs) from the BSG/ACPGBI guidelines2
Results 61 complex LNPCP cases were managed via the MDM with 8 excluded from analysis (7: managed prior to MDM referral, 1: MDM advice not followed), 27 lesions were managed with primary endotherapy, 23 with primary surgery and 3 cases conservatively. Of the endoscopic cases, 2 required surgery due to failed endotherapy and 2 due to a finding of malignancy. 12 month recurrence was 8.7% with no reported complications. The rate of surgical management using the BSG/ACPGBI KPI (including only surgically managed benign lesions or lesions subject to failed endotherapy) was 39.5%. The en-bloc resection rate of complex LNPCPs with features suggestive of increased malignancy risk was 71.4%.
Conclusion Despite our series focusing on complex LNPCPs only, endoscopic 12 month outcomes remained within accepted BSG/ACPGBI standards (<10% recurrence) 1. Whilst the use of surgery was considerable (39.5%), this likely reflects the complex nature of this series with all except 2 lesions (appendiceal orifice lesions unsuitable for endotherapy) managed surgically classified as SMSA level 4, and all subject to detailed discussion beforehand1. We propose that dividing the KPI assessing surgical management of LNPCPs into SMSA 4, SMSA 3 and high malignancy risk may enable more optimal assessment of the quality of decision-making processes in this area. The findings from the complex polyp MDM support its continuation to develop a larger dataset and obtain detailed statistical analysis.
. Chattree A, Nylander D, Silcock J, et al. UEG15-ABS-1622. Marked Variation in Endoscopic Mucosal Resection Outcomes Within the UK Bowel Cancer Screening Programme. United European Gastroenterology Journal 2015; 2015: (Suppl 1).
2. Rutter MD, Chattree A, Barbour JA, et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland Guidelines for the Management of Large Non-Pedunculated Colorectal Polyps. Gut 2015; 0:1–27.
Disclosure of Interest None Declared
- colonic polyps
- Endoscopic Resection