Authors
D. TATE (1), L. DESOMER (2), N. BURGESS (1), H. AWADIE (1), S. HEITMAN (3), N. FORBES (3), D. DE LOOZE (4), J. ANDERSON (5), D. REX (6), M. BOURKE (1) / [1] Westmead Hospital, Sydney, Australia, Gastroenterology and Hepatology, [2] AZ Delta, Roeselare, Belgium, Gastroenterology and Hepatology, [3] Cumming School of Medicine, University of Calgary, Calgary, Canada, Gastroenterology and Hepatology, [4] Ghent University Hospital, Ghent, Belgium, Gastroenterology and Hepatology, [5] Cheltenham General Hospital, Cheltenham, United Kingdom (the), Gastroenterology and Hepatology, [6] Indiana University School of Medicine, Bloomington, United States (the), Gastroenterology and Hepatology
Introduction
Multiple evidence-based guidelines have been produced recently to address the question of how best to perform colonoscopic polypectomy.
Aim
We aimed to assess the adherence to these guidelines in 7 countries using an online survey, comparing responses to the standards presented in the 2017 ESGE Colorectal polypectomy guideline.
Methods
An institutional review board approved online survey was distributed to the members the gastroenterological and surgical societies of 7 countries via email during July 2017. The survey presented images of colorectal polyps and their colonic location and asked for the polypectomy technique respondents would use in their daily practice. A reminder email was sent after two weeks and the survey closed after 4 weeks.
Results
772 endoscopic practitioners responded to the survey. 707 (91.6%) fully completed the survey and their data was analysed. 162, 155, 131, 102, 60, 53 and 45 respondents were from Australia, USA, UK, Belgium, Canada, Israel and New Zealand respectively. 625/707 (88.8%) were physicians, 9.9% were surgeons and 1.3% were nurse endoscopists. Respondents had a median endoscopy practice duration of 18 years (IQR 10-27). Of two images of <10 mm right sided colonic polyps presented, 51.1% of respondents suggested they would perform cold snare polypectomy in line with guidance. 11.2%, however, suggested cold biopsy forceps and 37.7% suggested endoscopic mucosal resection (EMR) / hot snare polypectomy. Of two large 20 and 45mm transverse colon LSLs with no endoscopic evidence of SMIC, 80.9% suggested EMR, undertaken themselves (48.3%) or referred (32.6%) to another practitioner in line with guidance. 13% would have biopsied the 45mm lesion prior to referral. 9% suggested they would refer these lesions directly to a surgeon. Regarding an image of a large 80mm sigmoid lesion with an endoscopically visible demarcated area consistent with deep submucosal invasive cancer, 51.6% said they would refer to a surgeon in line with guidance whereas 27% suggested they would attempt EMR, 1.4% ESD and the remainder refer the case to another endoscopic practitioner. Comparing the adherence to guidelines throughout all questions, surgeons (50%) were less adherent than physicians (65%), P = <.001, consultants (63%) similar to trainees (67%), P = .122 and those who had undertaken an interventional endoscopy fellowship (63%) similar those who had not (64%), P = .450.
Conclusions
These data demonstrate encouraging adherence to international guidelines. The work of international endoscopy societies should focus on encouraging the use of and promoting training in cold snare polypectomy for diminutive polypectomy and techniques for endoscopic imaging of large colorectal polyps.
