A111 EVALUATION OF REFERRAL COMPLETENESS FOR LARGE NON-PEDUNCULATED POLYPS IN LIGHT OF RECENT INTERNATIONAL CONSENSUS: A SINGLE-CENTER STUDY

TL;DR

This study examines how well current referral practices for large non-pedunculated colorectal polyps align with international guidelines, finding significant gaps that could affect patient care.

Contribution

The study identifies deficiencies in referral completeness for colorectal polyps and highlights the need for improved adherence to international consensus guidelines.

Findings

Only 38% of referrals included video or photo documentation, with 44% of those being sufficient.

Polyp size was reported in only 50% of referrals, despite its importance for planning.

Correlation between referring endoscopist and expert assessment was strongest for anatomical location (r=0.82).

Abstract

Endoscopic mucosal resection (EMR) is standard-of-care for treating large non-pedunculated colorectal polyps yet often requires referral to expert centers. Hence, inclusion of important information to the therapeutic endoscopist is essential for pre-procedure planning. A recent international consensus statement, comprised of 19 components, aims to improve triage and planning of endoscopic resection for large non-pedunculated colorectal polyps. We sought to determine the current status of inclusion of these reporting elements in referrals to our tertiary center.

1- Report the rate of complete referrals in light of the international expert consensus statement

2- Investigate the degree of correlation of polyp adjudication between referring endoscopist and local advance therapeutic endoscopiest assessment

3- Explore factors predicting comprehensive reporting

Single-center review of prospectively collected colorectal polyp referrals for large non-pedunculated polyps from March 2021 to March 2023.

411 referrals for large polyps were received; median size 3 cm; 58% located in ascending colon. 89 % of referrals included the initial assessment date, and only 38% incorporated video or photo documentation, of which 44% were deemed sufficient to demonstrate polyp features. Anatomical location was reported in 96% of referrals, while polyp size was mentioned in only half of the referrals (50%). Polyp morphology was described in 91% as either sessile (n=360) or pedunculated (n=35). Paris classification was reported in 53% of referrals, and LST classification in 90%. 12% of referrals reported four elements of less, while 18% of referrals reported all elements. Correlations with our own endoscopic assessments were diverse, ranging from a robust correlation for anatomical location (r=0.82, 95%CI 0.78-0.86, p < 0.001) to a more modest correlation for Paris classification (r=0.44, 95%CI 0.35-0.52 p < 0.001).

Our study reveals deficiencies in current referral practices and emphasizes the consensus statement’s role in improving the process. Consequences of low-quality referrals may include compromised patient care, leading to delayed diagnoses, inappropriate treatments, and potentially compromised patient outcomes. Thus, we have identified a likely knowledge gap in polyp characterization among referring physicians that will be a focus of a subsequent QI initiative.

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