PTU-128 Complex colorectal polyp service in the southeast region: first annual results of a new service. (8th June 2018)

• Record Type: Journal Article
• Authors: Preziosi, Giuseppe; Papastergiou, Vasileios; Stasinos, Ioannis; Ha, Sun Mi; Fegredo, Justin; Bagla, Nipin; Muller, Andrew F; Sebastian, Joseph; Tsiamoulos, Zacharias P
• Is Part Of: Gut. Volume 67(2018)Supplement 1
• Page Start: A254
• Page End: A254
• Publication Date: 2018-06-08
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2018-BSGAbstracts.506
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Recently published Guidelines of the British Society of Gastroenterology (BSG) establish the standards of a Complex Colorectal Polyp (CCP) Service. We assessed the provision of a new CCP Service at East Kent University Hospitals Foundation Trust. Methods: We prospectively recorded our performance for resections of CCPs (low risk >2 cm-4cm/high risk >4 cm) from November 2016 to December 2017 and measured it against BSG standards: 1) interval time from referral to resection within 8 weeks, 2) resection types employed, 3) short term outcomes (follow up within 3–6 months) and complications. Results: 105 patients underwent 121 resection procedures (56 males, mean age 70.5±11.5 years). The interval time from referral to resection procedure was delayed >8 weeks in 36/105 patients (34%). Polyp resection was completed in one session in 116/121 cases (96%), >1 session in 2 cases and on 3 occasions the procedure was abandoned (suspected invasion). We performed 77 piecemeal-Endoscopic-Mucosal-Resection (pEMR), 8 hybrid pEMR/Endoscopic-Mucosal-Ablation (EMA), 8 hybrid pEMR/Endoscopic-Submucosal-Dissection (ESD), 8 Trans-Anal-Submucosal Endoscopic Resection (TASER), 7 free-hand ESD, 2 Laparoscopic-Assisted-Colonoscopy-Polypectomy (LACE) and 11 Serrated Cold Piecemeal Emr (SCOPE). Median overall polyp size was 3 cm (range 2/12). For 13/38 polyps with high-risk features (median size of 5 cm, range 4–12), otherwise destined for tertiary referral or surgery, we selected more endo-surgical and/or en-bloc resections: (TASER=7/ESD=4/LACE=2). 12 Polyps proved to have malignant features (11 within the high-risk group), all discussed at Colorectal MDM: 6/12 underwent colectomy, 2/12 local radiotherapy (T1 >1 mm +adverse histological features/patient preference) and 4/12 endoscopic surveillance (T1 <1 mm, no adverse histological features). In total, 7/105 (6.6%) patients had surgery (6 malignant/1 benign polyps). Of 98/105 patients treated: 41 (42%) did not have follow-up within 6 months, 31 (30%) are scheduled for follow-up and 27 (28%) had timely follow-up with a low (range 3–10 mm) recurrence rate (4/27, 13.8%), easily treated. No perforations or mortality were recorded. Four cases of delayed bleeding (3.8%) were documented: endoscopy was required in 2 for clipping. Conclusion: Our results demonstrated a safe and effective provision of a CCP service (96% complete excision in a single visit), as a result of a synergy between gastroenterologists and surgeons. However, we noticed an inadequate booking process, currently addressed by implementing new CCP pathways and setting up a CCP MDM.