National survey to determine current practices, training and attitudes towards advanced polypectomy in the UK

Abstract

Objective Developments in advanced polypectomy technique provide an alternative to surgery in the management of large and complex colorectal polyps. These endoscopic techniques require expertise and can potentially incur high complication rates. This survey evaluates current UK practice, attitudes and training in advanced polypectomy. Design Anonymous online questionnaire. Setting Colonoscopists within the UK were asked about their approach to large polyps (>2 cm). Results Among the 268 respondents (64% of whom were BCSP accredited), 86% were confident in removing lesions >2 cm by endoscopic mucosal resection (EMR). Of these, 27% were classed as low volume operators (<10 lesions resected/annum) and 14% as high volume operators (>50/annum).

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

“…Studies with similar methodology had response rates of 13-45 % [26][27][28][29][30]31], but significantly lower response pools (maximum 5030 versus 19 467 in this study) and therefore significantly fewer respondents [excepting the US only study [29]]. Such a large study on polypectomy with > 700 complete responses and contributions from seven Western countries has not previously been described.…”

Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects

“…40,41 As with colorectal ESD, debate continues in the West over the threshold for proceeding to this practice on a wider level with workforce competency and funding being two important considerations. 42,43…”

“SPECC and SPECULATION”: Is a significant polyp benign or an early colorectal cancer? How do we know and what do we do?

“…Random superficial biopsies are subject to sampling error and may be misleading, as the base of a colorectal neoplasm is the representative part where invasion occurs with confirmation of cancer. Despite this over 30% of a sample of UK endoscopists would routinely biopsy a potentially endoscopically resectable significant polyp, a procedure unlikely to help in the diagnosis of malignancy but one which risks fibrosis and tethering which may compromise a subsequent attempt at complete endoscopic resection .…”

“…An in vivo tattoo (3‐5 centimetres from the site) ‘documenting’ the location of an endoscopically treated SPECC is recommended to ensure accurate post–treatment surveillance or to allow precise localisation of the site if surgical resection is deemed necessary . While endoscopy image capture has improved substantially, video recording was only used by 20% of endoscopists for documenting ‘significant’ polyps .…”