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Background: Pre-resection biopsy (PRB) of large non-pedunculated colorectal polyps (LNPCPs, ≥20mm) is often performed before referral for endoscopic mucosal resection (EMR). How this affects the EMR procedure is unknown. Methods: Retrospective analysis of a prospectively collected cohort of patients with LNPCPs referred for EMR between 2013 to 2016 at an Australian tertiary centre. Outcomes were differences in PRB and EMR histology and effects of PRB on the EMR. Results: Amongst 586 LNPCPs, lesions having PRB were larger (median 35mm vs 30mm, P <0.001), and more likely morphologically flat or slightly elevated (P = 0.014). PRB histology was upstaged in 26.1%, down-staged in 13.8% and unchanged in 60.1% after EMR. Sensitivity of PRB was 77.2% (95% CI 71.1-82.4) for low grade dysplasia (LGD) and 21.2% (95% CI 11.5-35.1) for high grade dysplasia (HGD). Where EMR specimen showed HGD, PRB detected LGD in 76.9%. Where EMR specimen showed cancer, PRB detected dysplasia only. PRB was associated with more submucosal fibrosis (P = 0.001) and intra-procedural bleeding (P = 0.033). EMR success or recurrence was not affected. Conclusions: Routine PRB of LNPCP does not reliably detect advanced histology, and may affect EMR complexity. PRB should be utilised with caution in guiding endoscopic management of LNPCPs.

The cardiac axis in a structurally normal heart is influenced by a number of factors. We investigated the anatomical and electrical cardiac axes in middle-aged individuals without structural heart disease and compared this with age-matched obese and older individuals without structural heart disease. A retrospective study of controls included those between 30 and 60 years old with a normal body mass index (BMI), who were then compared with obese individuals between 30 and 60 years old and with individuals more than 60 years old with a normal BMI. The anatomical cardiac axis was determined along the long axis by cardiac computed tomography (CT) and correlated with the electrical cardiac axis on a surface electrocardiogram (ECG) in the frontal plane. A total of 124 patients were included. In the controls (n = 59), the mean CT axis was 38.1° ± 7.8° whilst the mean ECG axis was 51.8° ± 26.6°, Pearson r value 0.12 (P = 0.365). In the obese (n = 36), the mean CT axis was 25.1° ± 6.2° whilst the mean ECG axis was 20.1° ± 23.9°, Pearson r value 0.05 (P = 0.808). In the older group (n = 29), the mean CT axis was 34.4° ± 9.1° whilst the mean ECG axis was 34.4° ± 30.3°, Pearson r value 0.26 (P = 0.209). Obese individuals have a more leftward rotation of both axes than age-matched normals (P <0.0001), which could be secondary to elevation of the diaphragm. Older individuals have a more leftward rotation only of their electrical cardiac axis (P = 0.01), which could be a normal variant or reflect underlying conduction disturbances in this age group.