EXPERIENCE FROM A TERTIARY CENTRE FOR OPTIMAL MANAGEMENT OF PATIENTS REFERRED FOR COMPLEX ENDOSCOPIC PROCEDURES: AN ADVANCED ENDOSCOPY MULTIDISCIPLINARY TEAM MEETING

Aims Optimisation of patient care though multidisciplinary team (MDT) meetings is now established as the standard of care in cancer pathways. Cases presented at MDTs are discussed by a panel of experts in order to provide optimal management. An ‘Advanced-endoscopy MDT’ may help to achieve consensus on decision-making, clinical outcomes and patient satisfaction.

Methods In our tertiary referral institution, we developed and adopted an ‘Advanced-Endoscopy MDT’ to evaluate complex cases. A bi-weekly meeting was established with the presence of expert interventional endoscopists, radiologists, histopathologists, dedicated gastrointestinal surgeons and nurse endoscopists. Depending on the cases discussed, additional experts were also in attendance. Endoscopic images, radiological scans and histopathology reports were assessed in order to decide treatment options and surveillance intervals. We retrospectively reviewed all patients that were discussed. Demographic, clinical, endoscopic findings and outcome data were analysed.

Results Over 20 months, 35 meetings were conducted; 463cases were discussed for a total of 323 patients. The main reasons for MDT referral were for consideration of double-balloon enteroscopy (DBE) (107patients) and for appropriate endoscopic or surgical management of mucosal/submucosal GI lesions. Through MDT discussion, 9 patients were referred for surgical management; 34 patients were treated with endoscopic-submucosal-dissection (ESD) and 72 patients with endoscopic-mucosal-resection (EMR). One ESD procedure was abandoned due to high suspicion of deep invasion and was referred for surgery. From the remaining 33 cases, R0-margins were reported for 32/33 patients. Eight patients referred for DBE did not require endoscopic input and 29 cases were reviewed twice as additional radiological investigations or small bowel capsule endoscopy were deemed necessary. No major adverse event including perforation, severe delayed GI bleed or sepsis occurred after any endoscopic procedure discussed at the MDT.

Conclusions Based on our preliminary experience of an ‘Advanced-Endoscopy MDT’ is a useful platform for the safe, effective and efficient management of complex advanced endoscopic procedures.