Management of large non-pedunculated polyps in a Bowel Screen Centre
C.Rowan, B.Nolan , J.Sheridan, G.Cullen, H.Mulcahy, G.Doherty
St.Vincent's University Hospital, Dublin
The national bowel screening programme began in 2013 and since then over 130,000 people have been invited to participate in designated centres across the country. Many of these people will have large ≥2cm) complex polyps diagnosed at colonoscopy. Both endoscopic and surgical techniques can be used to resect these polyps but no formal consensus exists to guide clinicians as to the best option.
The aim of this study was to examine the management of large (≥2cm) non-pedunculated polyps detected during 1055 Bowel Screen colonoscopies performed at a single centre.
We performed a retrospective review of 1055 colonoscopies undertaken between January2013 and September 2015 in the Bowel Screen programme in our centre. All polyps ≤20mm, pedunculated polyps and lesions initially suspected of being carcinoma were excluded. Demographic data was collected. Endoscopic and histological reports were reviewed to confirm polyp size, characteristics and dysplasia grade.
44 patients with 50 non-pedunculated polyps over 20mm were identified. 38 polyps were managed endoscopically in the first instance; 3 polyps required secondary surgical intervention. (n=1 residual adenoma; n=1 invasive adenocarcinoma with deep margin involvement in endoscopic specimen; no residual disease was found in surgical resection specimen, n=1 failed combined laparoscopic –endoscopic resection of splenic flexure polyp). 7 patients were referred for primary surgical management from June 2013-June 2014, compared to 8 patients who underwent primary endoscopic therapy. In the latter half of the study period, only 3 patients (10.3%) were referred for primary surgical management whereas 26 patients were managed endoscopically. p=0.006. Please find table of patient demographics and polyp histology attached
The majority of non-pedunculated polyps ≥20mm (76%) were managed by primary endoscopic means in this centre. Only 3 polyps required a secondary surgical intervention, only 1 of whom had residual adenoma at the time of surgery. Patients with complex right sided lesions were more likely to undergo a primary surgical procedure than those with large left sided polyps. (p=0.02) However there was a significant trend towards primary endoscopic therapy as the Bowel Screen programme enrols more patients and endoscopists become more experienced in resecting complex polyps.