Introduction In recent years there have been considerable developments in polypectomy techniques. However, even among experienced colonoscopists, there remains a wide variation in practise. This survey attempts to evaluate current UK practise in more advanced polypectomy.

Methods NHS Bowel Cancer Screening Programme (BCSP) colonoscopists and BSG members were invited to complete an anonymous online questionnaire regarding their approach to large polyps.

Results Respondents: Complete responses were obtained from 268 colonoscopists practising independently in the UK. 75% were consultant gastroenterologists, 10% surgeons and 9% nurse endoscopists. 41% did at least one session in a teaching hospital. 64% were BCSP accredited. All regions were well represented in the survey, although there were only 2 responders from Wales. Median lifetime colonoscopy experience was 3000 and typical workload was about 10 procedures per week.

Experience & Practice: 86% felt confident to remove lesions > 2cm by endoscopic mucosal resection (EMR). 27% of this group had done < 10 EMR procedures in the previous year; 14% claimed > 50 EMRs per year. When asked to describe the most complex polypectomy they would undertake, 30% (81) judged themselves capable of resecting very large flat or polypoid lesions that are also suitable for surgery (i.e. Level 4 polypectomy). Of these Level 4 operators, 17% had never tackled a polyp greater than 5cm and 10% had performed < 10 EMRs in the previous year. Video recording was used in the assessment of difficult polyps by only 20%. 32% declared that they would routinely biopsy a potentially resectable polyp they did not feel comfortable to remove themselves, with 3.5% opting to snare a large piece for histology.

Endoscopic Submucosal Dissection (ESD) : 7 responders perform full ESD and a further 13 use ESD as part of a hybrid technique. 11% had referred a patient to another specialist for ESD in the last year.

Complications: Among those performing EMR, 10% admitted to a perforation in the previous year and 23% reported significant bleeding.

Conclusion This is the first “snap shot” of advanced polypectomy practise across the UK. Although the sample was self-selected, a range of experience is represented. Most experienced colonoscopists appear happy to attempt piecemeal EMR even if their annual numbers are low. As expected, very few colonoscopists are performing ESD. A surprising number of colonoscopists regarded themselves as Level 4 experts, suggesting that the current definition of what constitutes very advanced practise needs to be modified, or at least better defined. The limited use of video documentation is disappointing and unhelpful practises, such as routine polyp biopsy (or partial polypectomy), are still relatively common

Disclosure of Interest J. Geraghty Grant/Research Support from: COOK MEDICAL, P. O’Toole: None Declared, J. Anderson: None Declared, R. Valori: None Declared, S. Sarkar: None Declared