Volume of surgery for benign colorectal polyps in the last 11 years

Bronzwaer, Maxime; Koens, Lianne; Bemelman, Willem A.; Dekker, Evelien; Fockens, Paul; Beaumont, Hanneke; Tuynman, Jurriaan B.; Bruin, G. de; Geloven, A. A. W. van; Slot, W. Bruins; Hulst, R. W. M. Van Der; Vuylsteke, R. C. L. M.; Cahen, Djuna L.; Baan, A; Dekkers, P. E. P.; Boer, Frank C. den; Depla, A.T.C.M.; Bruin, Sjoerd C.; Jansen, Jade; Gerhards, Michael F.; Stokkers, P.C.F.; Tets, Willem F. van; Mundt, Marco W.; Ven, Anthony W. H. van de; Peters, Jeannette B.; Cense, Huib A.; Spek, Bas W. van der; Dunker, M. S.; Leerdam, Monique E. van; Aalbers, Arend G. J.; Vlug, Malaika S.; Sonneveld, D J A

doi:10.1016/j.gie.2017.10.032

Cited by 47 publications

(40 citation statements)

References 35 publications

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“…However, the positive predictive value in this study was quite low at 69% (95% CI 57 to 78), which resulted in unnecessary surgery. This was also shown in other studies 19 20. Hence, we can conclude that incorrect optical diagnosis for predicting SM and SMd invasion results in suboptimal use of endoscopic and surgical treatment options, resulting in both overtreatment and undertreatment.…”

Section: Commentssupporting

confidence: 83%

Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme

Vleugels

Koens

Dijkgraaf

et al. 2019

Gut

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Section: Commentssupporting

confidence: 83%

Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme

Vleugels

Koens

Dijkgraaf

et al. 2019

Gut

Self Cite

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“…In Europe, a recent Dutch study showed that patients with large and complex colorectal polyps are still frequently referred for surgical treatment. These referrals should decrease, because colorectal surgery is known to be associated with significantly higher morbidity and mortality rates (34.8% and 1.4%, respectively) than endoscopic treatment [29]. Implementing ESD could reduce the need for surgery for complex polyps in the West.…”

Section: Discussionmentioning

confidence: 99%

The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

Zabala

Parra‐Blanco

Beg

et al. 2019

Preprint

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Background Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. The use of hydrodissection has been established as an effective technique for safe resection. However, it is unknown if the adoption of this technique can help a novice perform ESD safely without prior experience or formal tutorial. Here we aimed to determine the results of the introduction of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique, at a European tertiary hospital. Methods This study included data from 80 consecutive CR-ESDs performed for complex colorectal polyps, by a single endoscopist within a structured training program. The main outcome was en bloc resection rate, while secondary outcomes included complications (perforation and bleeding), knife en bloc (KEB) resection rate, knife-snare en bloc resection rate, conversion rate to endoscopic piecemeal mucosal resection (EPMR), complete resection rate, curative resection rate. To explore the impact of experience, procedures were divided into 4 groups of 20 each, with outcomes measures compared between these. Results The overall en bloc resection rate was 75%. KEB resection was obtained in 15%, 25%, 50%, and 80% cases in the consecutive periods (period 1 vs 4, p<0.001; periods 1, 2 and 3 vs 4, p<0.001). Conversion rate to EPMR was obtained in 40%, 25%, 25% and 5% respectively (period 1,2 and 3 vs 4; p=0.031). Curative resection was achieved in 55%, 75%, 70% and 95% respectively (p=0.037). Series results were 75% R0 resection, 23.7% conversion to EPMR, and 1.2% incomplete resection. Complications included perforations (7.5%) and bleeding (3.75%), there was no significant difference in the 4 periods of training. Multivariate analysis revealed factors more likely to result in non-en bloc versus en bloc resection were polyp size > 35 mm [70% vs. 23.4%; OR 13.2 (95% CI: 1.7-100.9); p=0. 013], severe fibrosis [40% vs. 11.7%; OR 10.2 (95% CI: 1.2-86.3); p= 0.033] and non-use of CO2 [65% vs. 30%; OR 0.09 (95% CI: 0.01-0.53); p= 0.008]. Conclusions CR-ESD by hydrodissection can be implemented in a western centre and offers safe and effective treatment for complex polyps.

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“…Furthermore, despite the higher morbidity-mortality rate of surgical resection, when the first-line endoscopists could not remove benign LPs themselves, they referred patients to a surgeon twice as often as to a more experienced endoscopist (8,14). This led to a non-negligible volume of surgeries for benign LPs, avoidable in 32% to 74% of cases if patients had been referred to expert endoscopists (13,14,21). Surgery was definitely unwarranted in more than 60% of our benign LP patients who were As previously reported, the risk of malignancy was three-fold and two-fold higher for LPs located in the rectum and sigmoid respectively compared with the rest of the colon (31,32).…”

Section: Colonoscopies and Polypsmentioning

confidence: 99%

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

Denis¹,

Gendre

Perrin

et al. 2020

Preprint

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Objective: To analyse presentation, management and outcomes of large (≥ 20 mm) polyps (LPs) detected in a colorectal cancer (CRC) screening programme using a faecal immunochemical test (FIT) and to compare them with those of a previous guaiac-based faecal occult blood test (gFOBT) programme. Design: Retrospective population-based study of all LPs detected in patients aged 50-74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening programme organised in Alsace (France). Results: Overall, 1256 LPs (8.5% malignant and 51.8% non-pedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). Endoscopic resection rate was 82.7% for benign LPs (70.2% non-pedunculated, 95.2% pedunculated, p<0.001), varying from 0 to 100% depending on the endoscopist. The sensitivity of optical diagnosis of malignancy was 54% for non-pedunculated and 27% for pedunculated T1 CRCs. Endoscopic resection was curative for 4.3% of non-pedunculated and 37.8% pedunculated T1 CRCs. One surgery was avoided for 57 endoscopic submucosal dissections. Management practices did not vary significantly between the gFOBT and FIT periods. Conclusion: Compared with current recommendations, there is tremendous room for improvement of community endoscopy practices for the diagnosis and management of LPs. Endoscopic resection is curative in 15.9% of T1 CRCs only. The benefit of endoscopic submucosal dissection is marginal in community practice.

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Volume of surgery for benign colorectal polyps in the last 11 years

Cited by 47 publications

References 35 publications

Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme

Suboptimal endoscopic cancer recognition in colorectal lesions in a national bowel screening programme

The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a population-based study

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