{
  "abstract": "Introduction A County wide Complex polypectomy service has been an essential part in the management of advanced colorectal polyps within the Symptomatic as well as Bowel Cancer screening (BCSP) pathways since 2010, mainly through referral letters from clinicians.Methods A comprehensive enhanced complex polypectomy pathway was introduced in September 2023. Key features include: an Outlook based E-Referral system including Size, Morphology, Site, Access (SMSA) score, dedicated booking team, a customised information leaflet and a service specific consent form 1 with potential complications and further interventions, weekly polyp MDT and automatic scheduling for site check. The enhanced service pathway was evaluated against the recently published BSG-ACPGBI guidelines, as well as factors influencing treatment decisions, by retrospectively applying Charlston Comorbidity Index (CCI) and Red Amber Green (RAG) rating on our patient cohort. This is a retrospective study on all polyps referred as complex (treatment Level 3 or more), between 01/01/2024 and 30/06/2024 with follow-up till date. Patients were identified from sources defined apriori, including Colorectal MDT, complex polypectomy e-referrals, and BCSP. Numiqo was used for statistical analysis.Results 155 patients were identified of whom, 19 were excluded as polyp not perceived to be complex. Male female ratio was 63%/37% with median ages of 72.5 and 74 respectively. WHO performance status score of 0, 1, 2 were seen in 50%, 35% and 10%, respectively.Key Performance Indicators table 1:On retrospective application of CCI and RAG rating, 30 patients were classified as Red, of whom 18, underwent a procedure and 4(22%) died within 1 year, unrelated to the procedure. Age(p-value 0.022) and the WHO performance status(p-value 0.009) were found to have significantly influenced our decision whereas the retrospectively applied Charlson Comorbidity Index(p-value 0.054) and RAG(p-value 0.072) did not reach statistical significance.Conclusions Our Enhanced Complex polypectomy service provides a streamlined pathway from the time of diagnosis to follow-up, integrating informed MDT decision, patient fitness, and automatic scheduling for surveillance as well as facilitating data access for audit. Incorporating CCI and RAG prospectively will aid informed decision making, to improve appropriateness, timeliness, fully informed consent and patient safety.Abstract P342 Table 1SMSA scoreMedian [95%CI]12[10-14]Complex polyp MDT77%Decision Making%(n)Local Endoscopy57%(77)Local Surgery18%(24)Tertiary treatment6%(8)Unsuitable for treatment7%(10)Patient declined/ Died12%(17)Time to treatmentDays [95%CI]Local EndoscopyMedian–41[38-69]26.31% within 7 daysLocal SurgeryMedian–113[84-191]Tertiary treatmentMedian– 214[98- 331]Local Endoscopy Performance DataService specific Consent 150%Success rate98%Complication rate0%3-month site check80%1 year site check64%Recurrence rate4%",
  "authors": [
    {
      "affiliations": [
        "United Lincolnshire Teaching Hospitals, Lincoln, United Kingdom"
      ],
      "name": "Vishnuvardan Venkatramanan"
    },
    {
      "affiliations": [
        "Leicester Medical School, University of Leicester, Leicester, United Kingdom"
      ],
      "name": "Archana Sreedharan"
    },
    {
      "affiliations": [
        "United Lincolnshire Teaching Hospitals, Lincoln, United Kingdom"
      ],
      "name": "Lathurshaan Janarththanan"
    },
    {
      "affiliations": [
        "United Lincolnshire Teaching Hospitals, Lincoln, United Kingdom"
      ],
      "name": "Anthony Norman"
    },
    {
      "affiliations": [
        "United Lincolnshire Teaching Hospitals, Lincoln, United Kingdom"
      ],
      "name": "Aravamuthan Sreedharan"
    }
  ],
  "title": "P342 Audit of complex polypectomy service in a large rural county",
  "uid": "8bff3fbd-7e0a-5c59-927b-eb307ee0ef1c"
}