Introduction The four recommended classifications of polyps are Paris, Kudo, Showa and Histological. Based on these the endoscopist can risk stratify polyps for dysplasia and neoplasia. This study evaluates the utilisation of these classifications by trained endoscopists upon detecting colonic polyps at four district hospitals in the United Kingdom.
Method All patients who had a polyp detected at flexible sigmoidoscopy or colonoscopy over six months in four sample district hospitals of United Kingdom were retrospectively identified. Total of 979 cases were recruited. Endoscopists of all seniority level were included in the study The reports were reviewed either electronically or manually. Data was tabulated for seniority of the endoscopist, polyp description, polyp characterisation, and utilisation of the four classifications. As the four district hospitals participating in the study are managed by the same NHS Trust, ethics approval was granted through clinical governance and audit department.
Results Our study showed that at least 20% reports did not have adequate polyp description and did not use Paris classification. It was worst for Kudo classification which was not used in 95.3% reports. Showa classification was not used at all. More than half of the recruited procedures were reported by Consultants (665). Others were reported by Associate Specialists or Registrars (248) or Nurse Endoscopists (66). There was no variation in utilisation of polyp classifications based on level of seniority of the endoscopist. The study did not analyse whether the endoscopist was aware of the polyp classifications.
Conclusion This study has shown lack of adequate utilisation of the four recommended classifications of colonoc polyps in four district hospitals of United Kingdom regardless of the seniority of the endoscopist. These classifications help in risk stratifying for dysplasia and cancer. It is therefore important to recognise this aspect for quality in colonoscopy and flexible sigmoidoscopy. There can be many reasons for not using the classifications including; lack of awareness, disagreement with validation of the classifications, time constraints etc. Further studies are warranted to look at the causes for lack of compliance and impact on risk stratification for dysplasia or cancer.
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Editorial: Trouble in Paris (Classification): Polyp Morphology Is in The Eye of The Beholder. The American Journal of Gastroenterology 110, 188–191 (January 2015) | doi:10.1038/ajg.2014.411
Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc. 1996;44:8–14
Disclosure of Interest None Declared
- colonic polyps
- Kudo classification
- Paris classification
- Showa Classification