OTH-01 A complex lower gastrointestinal polyp MDT improves evidence-based decision making and efficiency of endoscopy scheduling. (June 2019)

• Record Type: Journal Article
• Authors: Sehgal, Vinay; Yearwood, Alice; Chaudhry, Mehreen; Samaan, Mark; Fawkes, Jonathan; Teixeira, Marta Da Silva; Corpus, Melanie; Mendoza, Mr Charleston; Seward, Edward; Vega, Roser
• Is Part Of: Gut. Volume 68(2019)Supplement 2
• Page Start: A220
• Page End: A221
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.420
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Demand for lower gastrointestinal (LGI) endoscopy in the UK has doubled (1). In an increasingly ageing and co-morbid population, multi-disciplinary team (MDT) discussion is necessary to plan complex endoscopic resection (ER) within 8 weeks in an already overstretched service (2). We established a LGI complex polyp MDT meeting to meet this need and assessed if this process improved utilisation of therapeutic endoscopy points and scheduling efficiency. Methods: A weekly MDT including schedulers, clinical endoscopists, specialist registrars and 2 expert endoscopists (EE) was held (Oct'18 – Feb'19). All cases discussed at the MDT had an initial referral for endoscopy. Cases were divided into known polyp/s to discuss ER, those with previous complex ER requiring surveillance and patients with CT colonography (CTC) positive for polyps. Polyp complexity was assessed by SMSA score (3). Patients for ER were assigned a points value for scheduling and a decision made if an EE was needed. Outcomes were compared to the initial referral to look for changes in management plan and points allocated. Results: In total, 115 patients were discussed (Table 1 ). Median SMSA score for each group was 8. 7 patients did not require further endoscopy. 15 patients were referred for ER. 35 patients had previous ER and surveillance scheduled. Compared to the original referral, the management plan for 57 patients (49%) was changed saving 55 points. 90 cases required an EE saving 35 points. Conclusions: A complex polyp MDT changed the original management plan in half of patients referred and improved capacity with 3 lists saved (12 points/list) for polyps requiring expert ER. Such an MDT should be used in all centres that perform complex, high volume endoscopy. 1. Scoping the future. CRUK, 2015 2. BSG guidelines for management of large non-pedunculated colorectal polyps. Rutter MD, Chattree A, Barbour JA et al. Gut 2015 3. The SMSA scoring system for determining the complex of a polyp. Gupta S, Miskovic D, Bhandari P, et al. Gut Suppl 2011