PWE-041 Management Of Large Colonic Polyps In A Bowel Cancer Screening Programme. (9th June 2014)

• Record Type: Journal Article
• Authors: Lee, HY; Gashau, W; Willert, R
• Is Part Of: Gut. Volume 63(2014)Supplement 1
• Page Start: A140
• Page End: A140
• Publication Date: 2014-06-09
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2014-307263.301
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Bowel cancer is the third most common cancer in the United Kingdom forming up to 13.6% of all newl1y diagnosed cancers (1). Bowel cancer screening colonoscopy allows early polyp detection at a curable stage. Complete resection and follow-up of large polyps is crucial to prevent malignant progression. The aim of this study was to review the management of polyps with diameters ≥2 cm, particularly of sessile polyps, to assess the enbloc resection rates, completeness of resection using endoscopic mucosal resection (EMR) vs surgery and the incidence of malignant polyps. Methods: Patients were identified retrospectively from a regional bowel screening programme database. Details of index colonoscopy including polyp characteristics, method of resection and complications were recorded. Histology results were reviewed for all polyps. Outcomes from follow-up endoscopic surveillance were analysed. Results: One hundred and fifty-eight patients (102 males, 56 females, mean age 66.2 years) with polyps ≥2 cm were identified from 2182 screening colonoscopies from January 2010 to August 2013. Caecal intubation rate was 96.8% in this group. Largest polyp size for each patient ranged from 20 to 60 mm (mean 26.6 mm). The incidence of adenocarcinoma was 11.9% (n = 19), all located within the left colon, with 12 requiring surgical resection. One hundred thirty nine patients (n = 139) had 155 non-malignant large polyps, mostly tubulovillous or villous histology (n = 110, 79%). Thirty-six patients had 37 sessile polyps which underwent primary resection by EMR (n = 26) or surgery (n = 11). Polyp diameter was larger in the surgery group with mean polyp diameter of 40.4 vs. 28.0 mm (p < 0.05). EMR enbloc resection rate was 11.5% (n = 3 out of 26). Completeness of excision was 38.4% (n = 10) at 3 months and 92.3% (n = 24) at 1 year. EMR complications included 1 perforation, 1 post polypectomy syndrome and 1 bleed. Surgical resection included: anterior resection in 2, TEMS excision in 7 and right hemicolectomy in 3. Conclusion: Sessile polyps ≥2 cm are relatively uncommon in an asymptomatic bowel cancer screening programme (37 in 2182 colonoscopies). They can be successfully resected by EMR without recurrence in 92.3% at 1 year providing a 3 month site check is performed in all piecemeal polypectomies. Reference: Cancer for National Statistics 2010. Office for National Statistics. http://www.ons.gov.uk/ons/dcp171778_263537.pdf Disclosure of Interest: None Declared.