{
  "abstract": "Introduction Colonoscopy with polypectomy is central to colorectal cancer prevention through the removal of benign polyps prior to malignant transformation. As the population ages, an increasing number of patients undergoing endoscopic therapy have significant comorbidity, yet the effect of comorbidity burden on outcomes following benign polypectomy remains unclear.Methods A retrospective audit was conducted of 194 consecutive patients who underwent colonoscopy with polypectomy for benign colorectal polyps at the South Eastern Health and Social Care Trust, Northern Ireland. Patients with malignant polyps or colorectal cancer were excluded. Data collected included Charlson Comorbidity Index (CCI) score, post-procedural bleeding, hospitalisation, polyp recurrence at surveillance colonoscopy, and all-cause mortality at follow-up. Patients were stratified into low (CCI ≤ 2), moderate (3–5), and high (≥ 6) comorbidity groups. Associations between CCI category and outcomes were tested with chi-square analysis.Results A total of 194 patients were included (median CCI 3, range 0-10). 33.5% were low-CCI, 52.5% moderate-CCI and 14% high-CCI.During follow-up, 18 patients (9.3%) died from all causes. All deaths occurred among patients with CCI ≥ 3. Mortality increased significantly with higher comorbidity, rising from 0% in low-CCI patients to 7.8% in moderate and 37.0% in high-CCI groups, showing a significant trend (χ2 = 31.6, p < 0.001).Post-polypectomy bleeding occurred in two patients (1.0%), one with CCI 1 and one with CCI 8. Nine patients (4.6%) required hospitalisation following the procedure, primarily within the moderate and high CCI groups.Polyp recurrence was identified in 21 patients (10.8%). Recurrence occurred in 4 patients (6.2%) in the low-CCI group, 7 patients (6.9%) in the moderate group, and 10 patients (37.0%) in the high-CCI group, representing a significant association between comorbidity burden and recurrence (χ2 = 11.0, p = 0.004).Of the 21 recurrences, nine were detected at first surveillance colonoscopy (22% low, 44% moderate, 33% high CCI). Six patients developed new recurrence at second surveillance (33% low, 17% moderate, 50% high), and six at third surveillance (17% low, 50% moderate, 67% high). Persistent polyp detection across consecutive surveillance procedures occurred in three patients, all with CCI ≥4, including one patient with CCI 10.Patients with CCI ≥6 accounted for one-third of all recurrences and over one-third of total mortality despite representing less than 15% of the cohort.Conclusions This audit demonstrates a clear and statistically significant association between comorbidity burden and both all-cause mortality and polyp recurrence following colonoscopic polypectomy for benign polyps. Although immediate procedural complications were uncommon across all comorbidity groups, long-term outcomes differed substantially, with both mortality and recurrence increasing sharply in patients with a CCI ≥ 6.Analysis of recurrence patterns revealed that patients with higher CCI scores not only had greater overall recurrence rates but were also more likely to experience persistent polyp detection across successive surveillance procedures.These findings suggest a potential threshold of CCI ≥ 6, beyond which the benefits of repeated endoscopic intervention for benign lesions may be outweighed by procedural burden and limited life expectancy. In such cases, an individualised approach including careful risk-benefit assessment should be considered.Routine integration of frailty and comorbidity assessment into colonoscopy pathways may improve patient selection, guide individualised management, and support more informed discussions regarding the long-term risks and benefits of benign polypectomy in comorbid populations.",
  "authors": [
    {
      "affiliations": [
        "SEHSCT, Belfast, United Kingdom"
      ],
      "name": "Rachel Sheppard"
    },
    {
      "affiliations": [
        "SEHSCT, Belfast, United Kingdom"
      ],
      "name": "Darragh McCullagh"
    },
    {
      "affiliations": [
        "SEHSCT, Belfast, United Kingdom"
      ],
      "name": "Anthony McBrearty"
    },
    {
      "affiliations": [
        "SEHSCT, Belfast, United Kingdom"
      ],
      "name": "Katrina Battisti"
    }
  ],
  "title": "FP57 Impact of comorbidity burden on outcomes following colonoscopic polypectomy for benign disease: a retrospective audit using the charlson comorbidity index",
  "uid": "d057b6e0-f748-5a57-9ccb-cf077d2f7fda"
}