COMPLEX COLORECTAL POLYP SERVICE IN THE SOUTHEAST REGION: FIRST ANNUAL RESULTS OF A NEW SERVICE

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 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.