{
  "abstract": "Introduction and Aim The British Society of Gastroenterology (BSG) recommends interval endoscopic follow up for large non-pedunculated colorectal polyps [LNPCP] ≥ 20mm post-endoscopic piecemeal resection.The recommended interval follow up is 2-6 months site check, followed by 1 and 3 years interval colonoscopy if no recurrence or residual adenoma detected.1 2We aim to evaluate our Bowel Cancer Screening Service versus our symptomatic service with regard to timeliness for endoscopic follow up.Methods We carried out a retrospective observational study for patients who underwent colonic polypectomy for LNPCP ≥ 20mm between 1st January 2017 to 31st December 2018.Index and surveillance procedures performed by 2 endoscopists (RR, PW) were reviewed via individual endoscopy reports [GI reporting tool- Unisoft].Patients’ demographics, polyp size, morphology, method of resection and interval of endoscopic surveillance were reviewed.We excluded patients with colorectal cancer at index endoscopy, if en bloc resection was undertaken [with subsequent histological confirmation], patients who were not deemed fit /or if polyp wasn’t amenable for endoscopic resection and if patient chose not to undertake surveillance.Results Symptomatic ServiceThere were a total of 119 patients with LNPCP ≥ 20mm. Of which 79 patients met inclusion criteria. Excluded patients are described below:Colorectal cancer, n=11En bloc resection, n=4Not fit/or not amenable for endoscopic resection, n=19Patient chose not to undertake surveillance, n=4Patient died (other reasons), n=2Mean age was 66.9 years. 46 patients [58.2%] were male.All polyps were removed via piecemeal resection. The mean size was 37.6 mm [range 20-100 mm]. 50 polyps [60.9%] were sessile and 32 [39.1%] were lateral spreading lesions.Site check follow up at 2-6 months was undertaken in a timely manner on 74.6% [n=59]. The mean delay was 9.2 months.At 12 months surveillance, 16 patients were excluded [was not clear on the record whether they were booked for follow up endoscopy or not]. Of 63 patients only 17.4% [n=11] had their surveillance endoscopy on time. The mean delay was 13.5 months.At subsequent surveillance post 12 months, only 30% [n=9/30] had their surveillance on time.Fortunately no cancer was found on delayed follow up.Bowel Cancer Screening ServiceIn the BCSP service there were a total of 48 patients with LNPCP ≥ 20mm. 38 patients met the inclusion criteria and 10 patients were excluded as described below:Colorectal cancer, n=4En bloc resection, n=3Not fit/or not amenable for endoscopic resection, n=2Patient chose not to undertake surveillance, n=1Mean age was 63.5 years. 76.3% [n=29] were male.All polyps were removed via piecemeal resection. The mean size of polyps was 27.8 mm [range 20-50 mm].30 polyps [78.9%] were sessile and 8 [21.1%] were lateral spreading lesions.The site check follow up at 2-6 months was undertaken on time in 97.3% [n=37] of cases. The mean time for follow up endoscopy was 3.5 months.At 12 months surveillance, 3 patients were excluded [2 opted out and 1 had surgery around time of surveillance]. 85.7% [n=30] had their surveillance on time. The mean delay was 14.6 months.At subsequent surveillance post 12 months, all patients 100% [n=10/10] had their surveillance on time.Conclusion There was a significant difference in timeliness of follow up between the BCS and symptomatic services at all follow up intervals.These findings highlight the challenges faced by endoscopy services. Delayed follow up of high risk lesions is putting patients at risk.References Rutter MD, East J, Rees CJ, et al. Gut Epub. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. doi:10.1136/ gutjnl-2019-319858.Rutter MD, Chattree A, Barbour JA, et al. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015;64:1847–1873.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Leicester NHS Trust, Leicester, United Kingdom"
      ],
      "name": "Mohamed Eisa"
    },
    {
      "affiliations": [
        "University Hospitals of Leicester NHS Trust, Leicester, United Kingdom"
      ],
      "name": "Richard Robinson"
    },
    {
      "affiliations": [
        "University Hospitals of Leicester NHS Trust, Leicester, United Kingdom"
      ],
      "name": "Peter Wurm"
    }
  ],
  "title": "P290 Follow up & timeliness of endoscopic mucosal resection for large sessile colorectal polyps ≥20mm: symptomatic vs. bowel cancer screening service",
  "uid": "f3b243c9-a49c-5b9e-bd8d-b22c2890405c"
}