Increasing the use of endoscopic resection for complex polyps: quality improvement begins with us

Grimm, Ian S.

doi:10.1016/j.gie.2020.05.042

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…As speculated, 19 challenges were reported in the knowledge of and access to complex polyps expertise. This may explain utilisation of surgical management where less invasive techniques may be possible.…”

Section: Discussionmentioning

confidence: 97%

“…To our knowledge, this is the first study assessing the influences on decision-making for complex colorectal polyps. An explanation for the high surgery rates for colonic polyps is needed, 19 and qualitative research gives a unique insight into practice. Clinicians advocated endoscopic management wherever possible but the availability of expertise, timely endoscopy and challenges in referrals were all reported barriers in achieving optimal management.…”

Section: Discussionmentioning

confidence: 99%

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Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists

Parker

Semedo

Shenbagaraj

et al. 2023

BMJ Open Gastroenterol

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ObjectiveEndoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and non-clinical factors influencing decision making when planning management.DesignSemi-structured interviews were performed among colonoscopists across the UK. Interviews were conducted virtually and transcribed verbatim. Complex polyps were defined as lesions requiring further management planning rather than those treatable at the time of endoscopy. A thematic analysis was performed. Findings were coded to identify themes and reported narratively.ResultsTwenty colonoscopists were interviewed. Four major themes were identified including gathering information regarding the patient and their polyp, aids to decision making, barriers in achieving optimal management and improving services. Participants advocated endoscopic management where possible. Factors such as younger age, suspicion of malignancy, right colon or difficult polyp location lead towards surgical intervention and were similar between surgical and medical specialties. Availability of expertise, timely endoscopy and challenges in referral pathways were reported barriers to optimal management. Experiences of team decision-making strategies were positive and advocated in improving complex polyp management. Recommendations based on these findings to improve complex polyp management are provided.ConclusionThe increasing recognition of complex colorectal polyps requires consistency in decision making and access to a full range of treatment options. Colonoscopists advocated the availability of clinical expertise, timely treatment and education in avoiding surgical intervention and providing good patient outcomes. Team decision-making strategies for complex polyps may provide an opportunity to coordinate and improve these issues.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists

Parker

Semedo

Shenbagaraj

et al. 2023

BMJ Open Gastroenterol

View full text Add to dashboard Cite

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“…As highlighted in the commentary by Grimm, 1 surgery for nonmalignant colorectal polyps remains a common practice in the United States, even though it has greater mortality, morbidity, and cost. [2][3][4] How can we improve?…”

Section: Management Of Nonmalignant Colorectal Polyps: Better Care Do...mentioning

confidence: 99%

Management of nonmalignant colorectal polyps: better care does start with us

Moon

Draganov

Yang

2020

Gastrointestinal Endoscopy

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Surgery Referral of Colorectal Polyps Based on Real-Time Optical Diagnosis Alone: There is More to this Than Meets the Eye

Yang

Draganov

2021

Gastroenterology

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But perhaps they should have said earlier because, from their own data, the PRS risk gradient appears to change continuously across the age range. Supplementary Table 4 shows that the odds ratio per standard deviation went from 1.75 to 1.60 to 1.52 to 1.44 as age increased from the 40s to 50s to 60s to 70s (P ¼ 3.44 Â 10 À10 ). On the log(odds ratio) scale, these risk gradients are 0.56, 0.47, 0.42, and 0.37, which is an almost linear decline of approximately 0.06, or 14%, per decade. This is an important observation, not the least because it is contrary to what has been found for breast cancer where the risk association for currently the best PRSs for overall, and for estrogen receptor negative cancer is not discernibly dependent on age (the risk gradient decreases by approximately 0.01 per decade; P ¼ 0.39). 2 This null age-dependency implies that, for breast cancer, the PRS might not be predicting death from breast cancer. On the other hand, for CRC, the negative age-dependency implies that the PRS is likely predicting death from this disease, and across a wide age range. Note that, if a PRS is predicting disease mortality, the average PRS would be expected to decrease with age at diagnosis for cases, and age for controls, but at a slower rate for the latter. 3 It is even more important to take into account this negative age-dependence because, as the authors state, "Analyses of PRS, along with environmental and lifestyle risk factors, might identify younger individuals who would benefit from preventive measures." Their data show that this statement is not only relevant to the prevention of CRC before age 50 years, but to prevention of CRC being diagnosed at least across the next 3 decades: there appears to be no threshold. As indicated by the strength of association with age and its P value shown previously, there is a vast amount of risk information on CRC diagnosed after age 50 years (89% of the study sample) that has not been used or commented on in the published paper.

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Increasing the use of endoscopic resection for complex polyps: quality improvement begins with us

Cited by 3 publications

References 11 publications

Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists

Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists

Management of nonmalignant colorectal polyps: better care does start with us

Surgery Referral of Colorectal Polyps Based on Real-Time Optical Diagnosis Alone: There is More to this Than Meets the Eye

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