The national development programme for the management of significant colorectal polyps supports the implementation of higher standards of the bowel cancer screening programme

Abstract

Aim

Introduction of the Bowel Cancer Screening Programme (BCSP) led to increased detection of significant colorectal polyps [SCP]. Management of SCP is a clinical dilemma and surgical resection [SR] is often regarded as overtreatment for a largely benign condition, amenable to less invasive endoscopic resection [ER]

Method

We reviewed all SCP, defined as sessile/flat polyps of >20 mm size, diagnosed in 2014 at 9 hospitals in the U.K. Polyps were considered morphologically benign on endoscopy, or had a biopsy with benign histology.

Results

383 patients were treated by primary ER (84%) or SR (12%). The mean size of SCP was 31 mm; 108 (28%) were diagnosed in the BCSP. Whilst there was no difference in the size (29 mm vs. 31 mm, P = 0.15) or the anatomical location (45% vs. 38% right-sided, P = 0.23) of SCP between BCSP and non-screening cohorts, BCSP patients had lower rates of SR (7% vs. 15%, P = 0.02), pre-treatment biopsies (58% vs. 74%, P < 0.01). Non-screening status was an independent risk factor for SR on multivariate analysis [OR: 2.52 (1.08–5.82), P = 0.03].

Conclusion

This disparity may be explained by the robust quality assurance of endoscopy within the BCSP. Standardization and education may improve outcomes, and to this effect, a national multi-disciplinary programme titled ‘Significant Polyps and Early Colorectal Cancer (SPECC)’ has been developed.