{
  "abstract": "Background Determining optimal management of colorectal polyps in patients with limited life expectancy of under 10 years can be difficult, due to challenges balancing an uncertain natural history of polyp progression to symptomatic malignancy versus the increased risk and consequences of polypectomy complications.Aim This British Society of Gastroenterology and Association of Coloproctologists of Great Britain and Ireland guidance aims to help clinicians and patients consider these risks to aid decision-making for polypectomy versus a conservative approach.Methods A guidance development group comprising 28 members was established, including gastroenterologists, colorectal surgeons, elderly care physicians, anaesthetists, epidemiologists, nurse endoscopists, a general practitioner and patient representatives. Estimates on life expectancy stratified by age and comorbidity, polyp dwell time for differing polyp sizes, cancer sojourn time and polypectomy complication rates for comorbid/elderly patients both on and off antithrombotic medication were collated from various literature searches. A model was created to compare the risk of symptomatic malignancy in a patient’s lifetime against the risk of significant complications.Results Following a modified Delphi consensus process and after three rounds of voting, 33 recommendations were made within 10 domains (principles, diagnostic investigation, life expectancy, polyp and cancer natural history, polypectomy risks, management recommendations, follow-up, decision-making practicalities, training and education, future research). A table was created, summarising whether polypectomy or conservative management might be the favoured option for 40 clinical scenarios of patients with differing life expectancy, polyp sizes and use of antithrombotic medication.Conclusions This guidance provides a framework to facilitate more objective and informed decision-making, from which an individualised plan can be developed between the patient and their clinician.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK",
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Matthew D Rutter"
    },
    {
      "affiliations": [
        "Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK",
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Ravi Ranjan"
    },
    {
      "affiliations": [
        "Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK"
      ],
      "name": "Clare Westwood"
    },
    {
      "affiliations": [
        "Gastroenterology, QE Gateshead, Gateshead, Tyne and Wear, UK"
      ],
      "name": "Jamie Barbour"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK",
        "Public Representative, Newcastle, UK"
      ],
      "name": "Adam Biran"
    },
    {
      "affiliations": [
        "Geriatrics, University Hospital of North Tees, Stockton-on-Tees, UK"
      ],
      "name": "Helen Blackett"
    },
    {
      "affiliations": [
        "Gastroenterology, Mid-Yorkshire Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK"
      ],
      "name": "Nicholas Ewin Burr"
    },
    {
      "affiliations": [
        "Anaesthesia, Torbay and South Devon NHS Foundation Trust, Torquay, UK"
      ],
      "name": "John Carlisle"
    },
    {
      "affiliations": [
        "Public Representative, Darlington, UK"
      ],
      "name": "Barry Clare"
    },
    {
      "affiliations": [
        "Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK"
      ],
      "name": "Neil Cripps"
    },
    {
      "affiliations": [
        "Colorectal Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Peter Coyne"
    },
    {
      "affiliations": [
        "Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK"
      ],
      "name": "Sunil Dolwani"
    },
    {
      "affiliations": [
        "Geriatrics, University Hospital of North Tees, Stockton-on-Tees, UK"
      ],
      "name": "Rachel Hodson"
    },
    {
      "affiliations": [
        "Colorectal Surgery, Sunderland Royal Hospital, Sunderland, UK"
      ],
      "name": "Stephen Holtham"
    },
    {
      "affiliations": [
        "Gastroenterology, Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, UK"
      ],
      "name": "Noor Mohammed"
    },
    {
      "affiliations": [
        "Big Data Institute and Oxford Population Health, University of Oxford, Oxford, UK"
      ],
      "name": "Eva J A Morris"
    },
    {
      "affiliations": [
        "Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK"
      ],
      "name": "Laura Neilson"
    },
    {
      "affiliations": [
        "Raigmore Hospital, Department of Surgery, Inverness, UK"
      ],
      "name": "Raymond Oliphant"
    },
    {
      "affiliations": [
        "Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK"
      ],
      "name": "John Painter"
    },
    {
      "affiliations": [
        "Geriatrics, Noble’s Hospital, Isle of Man, UK"
      ],
      "name": "Anand Prakash"
    },
    {
      "affiliations": [
        "Colorectal Surgery, South Devon Healthcare Trust, Torquay, UK"
      ],
      "name": "Rupert Pullan"
    },
    {
      "affiliations": [
        "Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Sanchoy Sarkar"
    },
    {
      "affiliations": [
        "Sloan Medical Centre, Sheffield, UK"
      ],
      "name": "Marion Sloan"
    },
    {
      "affiliations": [
        "Anaesthesia and Critical care, Torbay and South Devon NHS Foundation Trust, Torquay, UK"
      ],
      "name": "Michael Swart"
    },
    {
      "affiliations": [
        "St Mark’s Hospital, London, UK"
      ],
      "name": "Siwan Thomas-Gibson"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK"
      ],
      "name": "Nigel J Trudgill"
    },
    {
      "affiliations": [
        "St Mark’s Hospital, London, UK"
      ],
      "name": "Margaret Vance"
    },
    {
      "affiliations": [
        "Colorectal Surgery, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK"
      ],
      "name": "Katie Yeadon"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Linda Sharp"
    }
  ],
  "title": "BSG/ACPGBI guidance on the management of colorectal polyps in patients with limited life expectancy",
  "uid": "636927c0-9f84-537f-bca9-5415e7ed1cee"
}