EFFECT OF TRAINING ON THE REFERRALS TO SURGERY FOR LARGE BENIGN COLORECTAL POLYPS

Aims Despite endoscopy is more efficient, safe and cost-effective than surgery for the treatment of large non-pedunculated benign colorectal polyps (LNBCP), still a large proportion of benign polyps are referred to surgery. We aimed to evaluate the effect of a specific training on the referral rate to surgery for LNBCP.

Tab. 1

Baseline polyp characteristics.

	Period before training (2013–2014) 93 polyps in 87 patients	Period after the training (2015–2018) 419 polyps in 354 patients	P value
Size, mean mm/Range (min – max)/Proportion of ≥ 40 mm (n, %)	26.7/(20–70)/7 (7.5)	30.5/(20–90)/81 (21.2)	0.007

Methods Benign non-pedunculated colorectal polyps ≥ 20 mm that were scheduled for EMR at dedicated list between January 2013 and December 2018 were retrospectively included in the analysis. One endoscopist underwent advance EMR training at a referral centre between 2014–2015 and after that implemented the know-how in the centre of origin and performed 35% of the EMRs. Efficacy of EMR was compared between pre-training (2013–2014) and after-training (2015–2018) period. The main outcome was rate of polyps referred to surgery for technical reasons.

Results In total 516 polyps in 445 patients were included; 93 polyps in 87 patients and 419 polyps in 354 patients in, pre- and post-training period respectively. Baseline polyp characteristics are shown in table 1. Polyps were larger and more difficult in post-training period. The number of polyps removed in a first attempt doubled in the post-training period (46.2% vs, 87.3%, respectively;

p < 0.001). The number of polyps that were referred to surgery because of technical difficulties decreased dramatically in the post training period: 21 (24.1%) vs. 6 (1.7%); p < 0.001). The rate of severe adverse events was similar in both periods: Two patients (2.3%) in pre-training period and

1 (0.3%) in post-training period were operated due to perforation after EMR.

Conclusions Specific training in EMR significantly increased efficacy of EMR for large non-pedunculated benign colorectal polyps and lead to decreased rates of surgery.