# 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.

## Key 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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Source: https://tomesphere.com/paper/PMC11807584