Increasing Rates of Surgery for Patients With Nonmalignant Colorectal Polyps in the United States

Peery, Anne F.; Cools, Katherine S.; Strassle, Paula D.; McGill, Sarah; Crockett, Seth D.; Barker, Aubrey; Koruda, Mark J.; Grimm, Ian S.

doi:10.1053/j.gastro.2018.01.003

Cited by 152 publications

(134 citation statements)

References 26 publications

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“…When there is suspicion of invasive growth, referral for en bloc endoscopic removal or surgery should also be considered 13 . However, even though advanced endoscopic alternatives are proven safe and effective 14,15 , multiple studies 16 -18 have shown that surgery for benign neoplasia is still common, and referral patterns vary widely 19 . For obvious reasons, formal segmental bowel resection results in higher morbidity and mortality rates compared with endoscopic resection 20 .…”

Section: Introductionmentioning

confidence: 99%

Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions

et al. 2019

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BackgroundA multicentre cohort study was performed to analyse the motivations for surgical referral of patients with benign colorectal lesions, and to evaluate the endoscopic and pathological characteristics of these lesions as well as short‐term surgical outcomes.MethodsPatients who underwent surgery for a benign colorectal lesion in 15 Dutch hospitals between January 2014 and December 2017 were selected from the pathology registry. Lesions were defined as complex when at least one of the following features was present: size at least 40 mm, difficult location according to the endoscopist, previous failed attempt at resection, or non‐lifting sign.ResultsA total of 358 patients were included (322 colonic and 36 rectal lesions). The main reasons for surgical referral of lesions in the colon and rectum were large size (33·5 and 47 per cent respectively) and suspicion of invasive growth (31·1 and 58 per cent). Benign lesions could be categorized as complex in 80·6 per cent for colonic and 80 per cent for rectal locations. Surgery consisted of local excision in 5·9 and 64 per cent of colonic and rectal lesions respectively, and complicated postoperative course rates were noted in 11·2 and 3 per cent. In the majority of patients, no attempt was made to resect the lesion endoscopically (77·0 per cent of colonic and 83 per cent of rectal lesions).ConclusionThe vast majority of the benign lesions referred for surgical resection could be classified as complex. Considering the substantial morbidity of surgery for benign colonic lesions, reassessment for endoscopic resection by another advanced endoscopy centre seems to be underused and should be encouraged.

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Section: Introductionmentioning

confidence: 99%

Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions

et al. 2019

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“…Nevertheless, scenarios like ours play out every day in the United States, where 1 in every 4 elective colectomies is performed for nonmalignant colorectal polyps. This practice shows no signs of abating, 12 despite fervent pleas that EMR by an experienced endoscopist should be the first-line treatment for large LSTs, for reasons of both efficacy and cost. [13][14][15][16] To improve the outcomes in patients with large colorectal polyps, endoscopists in the West would do well to emulate their Japanese colleagues.…”

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confidence: 99%

Look, but don’t touch: what not to do in managing large colorectal polyps

Grimm

McGill

2019

Gastrointestinal Endoscopy

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“…Thus, it is surprising that there is little data on EMR for large colorectal polyps, given its broader applicability to gastroenterology practice. Furthermore, it is imperative that endoscopists are able to effectively perform colon EMR in the United States, given the large number of surgical resections for benign colorectal polyps [12,26]. Ultimately, as further data on learning curves in colon EMR become available, a more sophisticated understanding of the teaching and learning process (beyond procedural volume thresholds) may lead to effective assessments of competency.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, it is considered standard of care over the invasive alternative of surgical resection for benign lesions, which is supported by the recommendations of the European Society of Gastrointestinal Endoscopy (ESGE) [2]. However, a recent study [12] showed an alarming increase in rates of surgery for benign colorectal polyps in the United States between 2000 and 2014. While the cause of this is not known, one hypothesized explanation relates to perceived risk of endoscopic removal of large polyps by endoscopists without adequate training in advanced resection techniques.…”

Section: Introductionmentioning

confidence: 99%

Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

et al. 2020

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Background and study aims Endoscopic mucosal resection (EMR) is standard treatment for large colorectal polyps. However, it is a specialized technique with limited data on the effectiveness of training methods to acquire this skill. The aim of this study was to evaluate the impact of observational training on EMR outcomes and competency in an early-stage endoscopist. Patients and methods A single endoscopist completed comprehensive EMR training, which included knowledge acquisition and direct observation of EMR cases, and proctored supervision, during the third year of gastroenterology fellowship. After training, EMR was independently attempted on 142 consecutive, large (i. e., ≥ 20 mm), non-pedunculated colorectal polyps between July 2014 and December 2017 (mean age 61.7 years; mean polyp size 30.4 mm; en-bloc resection 55 %). Surveillance colonoscopy for evaluation of residual neoplasia was available for 86 % of the cases. Three primary outcomes were evaluated: endoscopic assessment of complete resection, rate of adverse events (AEs), and rate of residual neoplasia on surveillance colonoscopy. Results Complete endoscopic resection was achieved in 93 % of cases, the rates of AEs and residual neoplasia were 7.8 % and 7.3 %, respectively. The rate of complete resection remained stable (at 85 % or greater) with increasing experience while rates of AEs and residual neoplasia peaked and decreased after 60 cases. Conclusions An early-stage endoscopist can acquire the skills to perform effective EMR after completing observational training. At least 60 independent EMRs for large colorectal polyps were required to achieve a plateau for clinically meaningful outcomes.

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Increasing Rates of Surgery for Patients With Nonmalignant Colorectal Polyps in the United States

Abstract: In an analysis of a large, nationally representative sample, we found that surgery for nonmalignant colorectal polyps is common and has significantly increased over the past 14 years.

Cited by 152 publications

References 26 publications

Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions

Multicentre study of surgical referral and outcomes of patients with benign colorectal lesions

Look, but don’t touch: what not to do in managing large colorectal polyps

Impact of observational training on endoscopic mucosal resection outcomes and competency for large colorectal polyps: single endoscopist experience

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