POTENTIAL IMPACT OF THE PROPOSED BSG/ACPGBI/PHE POST-POLYPECTOMY AND POST-COLORECTAL CANCER RESECTION SURVEILLANCE GUIDELINES AT AN IRISH BOWELSCREEN CENTRE

Aims The Irish BowelScreen program was instituted in 2012 as a cost-effective colorectal cancer surveillance programme. As the programme expands, surveillance procedures are also an expanding role of the programme in the setting of limited resources. Recent consensus guidelines were jointly commissioned by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England (BSG/ACPGBI/PHE) which take into consideration colorectal bowel screening data. We set out to investigate the potential impact of these guidelines if implemented at an experienced BowelScreen centre.

Methods We performed a retrospective analysis of patients discussed at the local BowelScreen histopathology multidisciplinary meetings (MDM) at the Mater Misericordiae University Hospital. Patients discussed at consecutive ten consecutive MDMs in 2019 were included in the analysis. Exclusion criteria included incomplete colonoscopy, incomplete polyp resection, endoscopic mucosal resection and patients discharged from BowelScreen were excluded from the analysis. MDM outcomes were analysed and a secondary outcome was retrospectively assigned using the colonoscopy and pathology reports discussed using the proposed guidelines.

Results Among the patient cohort, 124 received an outcome of Intermediate or High risk under current practice. One-year colonoscopy was recommended for 36 patients (high risk), with a three-year colonoscopy was recommended for the remaining 88 patients. The average time to surveillance was 2.4 years.

Overall, under the proposed guidelines, 48% of patients who are currently classified as intermediate or high risk could potentially be de-escalated to low risk and avoid colonoscopy surveillance. Of those undergoing surveillance colonoscopy, the proposed time to endoscopy could be extended to an average of 3 years.

Conclusions The proposed BSG/ACPGBI/PHE guidelines place more emphasis on the clearance of pre-malignant lesions and prioritises surveillance to patients who remain at high risk following clearance. Implementing these guidelines in the BowelScreen programme has the potential for significant reduction in surveillance procedures.