Clinical implications of decision making in colorectal polypectomy: an international survey of Western endoscopists suggests priorities for change

• DOI: 10.1055/a-1079-4298
• Publication Date: 2020-04-03T09:37:17Z
• Authors: David J. Tate; Lobke Desomer; Steven J. Heitman; Nauzer Forbes; Nicholas G. Burgess; Halim Awadie; Ian M. Gralnek; Jeroen Geldof; Danny De Looze; Douglas Rex; John Anderson; Michael J. Bourke
• Keywords: Polypectomy; Ascending colon; Endoscopic mucosal resection; Colorectal Polyp

Introduction Colonoscopy prevents colorectal cancer via the detection and resection of premalignant polyps. This effect may be attenuated by variations in polypectomy, with multiple techniques available a wide range experience amongst endoscopists. We assessed current practice against best contemporary evidence. Methods An online survey was distributed to members gastroenterological surgical societies seven countries during July 2017. Images polyps were presented respondents requested provide polypectomy technique they would employ their daily practice. Responses compared evidence-based 2017 ESGE Colorectal Polypectomy Guideline. Results In total, 707 endoscopists (627 physicians, 71 surgeons, 9 nurse endoscopists, median duration 18 years) completed survey. Of these, 3.1 % selected hot biopsy forceps 5.2 snare (without submucosal lifting) remove 3 mm ascending colon polyp. Only 43.3 cold (CSP) an 8 Surgical referral 16.7 for 45 transverse polyp without endoscopic evidence invasive (SMIC). Endoscopic 12.0 80 sigmoid imaging consistent deep SMIC, further 26.4 tertiary endoscopist referral, suggesting had not appreciated that it endoscopically unresectable. Conclusion CSP is underutilized small despite its favorable safety efficacy. Benign are commonly referred surgery overt SMIC underappreciated using imaging. Addressing these issues reduce diathermy-related adverse events, surgery, unnecessary colonoscopic procedures patients rates post-colonoscopy cancer.