UK BOWEL CANCER SCREENING PROGRAM: A LOCAL EXPERIENCE OF POLYPECTOMY FOR POLYPS ≥2CM

Aims:

The English National Health Service (NHS) Bowel Cancer Screening Program (BCSP) was introduced in 2006 to improve CRC mortality by earlier detection of CRC and has been associated with a 15% reduction in mortality. We wanted to study the outcome of large polypectomies under BCSP in our department.

Methods:

We analysed all patients in the BCSP at a District General Hospital between 1/1/11 and 1/1/17 and selected those who had polypectomies for polyps ≥2 cm in diameter. Data was obtained from electronic patient records and follow-up was for at least one year.

Results:

A total of 299 patients, (209 M, 90F, age range 61 – 91y, median 70y) had at least one polyp ≥2 cm at index colonoscopy. 75.9% of polyps (n = 227) were removed en bloc, the rest by piecemeal EMR (pEMR). Site of polyps were: rectum (42), recto-sigmoid (12), sigmoid (183), descending colon (13), splenic flexure (4), transverse colon (12), hepatic flexure (6), ascending colon (13) and caecum (14). Size of polyps: 20 – 29 mm (196), 30 – 39 mm (66), 40 – 49 mm (18), > 50 mm (19). Paris morphology where documented: 1 p (178), 1 s (92), 1sp (17), IIa (3), IIb (0), IIc (0), other (8). Polyp histology: carcinoma (4.7%, n = 14), tubulovillous adenoma (55.2%, n = 165), tubular adenoma (32.8%, n = 98), traditional serrated adenoma (1.7%, n = 5) and sessile serrated polyp (n = 1). 28 (9.4%) of patients underwent surgery, 4 of them with adenocarcinoma.

After initial polypectomy, one year follow up colonoscopy data was available in 116 patients. Of these, the polypectomy site was endoscopically clear in 103/116 (88.8%). The recurrence rate at 12 months increased with the size of the initial polyp, (20 – 29 mm = 5/75, 6.7%), (30 – 39 mm = 2/26, 7.7%), (40 – 49 mm = 3/5, 60%) and (50+mm = 3/10, 30%), p =< 0.05.

The complication rate was 2.3%(n = 7): 1 early bleed, 5 late bleeds and 1 suspected perforation (not seen at laparotomy). The others were managed conservatively.

Conclusions:

Polypectomy was effective in removing large polyps found during the BCSP. There was a statistically significant difference between polyp size and recurrence. The complication rate for large polypectomy was low.