P301 Innocent or guilty polyps ? A novel concept of a simplified ‘resect and discard’ strategyстатья
Аннотация:
Introduction
Optical Diagnosis (OD) based strategy (PIVI criteria) in the management of colorectal polyps has been a revelation in modern endoscopic therapy, however, studies have shown that OD in non- expert hands have not meet PIVI criteria, for both ' diagnose and leave' and 'resect and discard' strategies. We aim to create a simplified optical strategy which could accurately identify covert cancer as well as reduce the number of pathological examinations based on prevalence of cancer in 6–10 mm polyps.Methods
We analysed outcomes of all patients who underwent screening colonoscopy between January 2007 to December 2018 and were found to have polyps. Data was prospectively collected on an online endoscopy reporting system and pathology reporting system. Statistical analysis was performed using multinomial logistic regression.Results
A total of 15906 polyps were removed at colonoscopy over the specified period. Mean size was 7.3 mm (range: 1 to 120 mm). 86.6% of all polyps were non pedunculated and 56.3% polyps were located in the left colon. The size, site, morphology and histology of these polyps is shown in table 1. A histopathological diagnosis of polyp cancer was made in 104/15906 polyps (0.65%). 94/104 polyp cancers (90.25%) were associated with non pedunculated morphology [OR 1.45, 95%CI 0.75–2.78 p=0.005]. Risk of developing in cancer in polyps ≥20 mm was significantly higher than in smaller polyps [ OR 6.57 95% CI 5.7- 13.1 p< 0.001 ]. 89 cancers were found in the left colon and rectum compared with 15 cancers in the right colon ( 85.5% vs 14.5%) [OR 1.98, 95%CI 0.9–3.1 p=0.007].Conclusion
This is the largest report of the prevalence of cancer in colorectal lesions 6–10 mm in size. We have demonstrated that the prevalence of covert cancer in colorectal lesions <5 mm is negligible and that of polyps 6–10 mm is very low (0.17%). All these cancers were in non-pedunculated adenomas in left colon. Based on the data, we have demonstrated in the 6–10 mm polyp subgroup, we suggest a modified ' resect and discard' concept ( based on OD AND location based strategy) extending to 6–10 mm polyps in the right colon. Given the fact, that most non experts fail to reach PIVI criteria based on OD alone, this modified strategy would reduce the need for optical assessment and increase the scope of 'resect and discard' to a larger number of polyps.Год издания: 2021
Авторы: Ejaz Hossain, S Thayalsekaran, Sharmila Subramaniam, Sophie Arndtz, Maen Abdelrahim, Asma Alkandari, Pradeep Bhandari
Ключевые слова: Diverticular Disease and Complications, Microscopic Colitis, Clostridium difficile and Clostridium perfringens research
Открытый доступ: bronze
Страницы: A196.2–A197