P225 A multidisciplinary pathway for endoscopic management of complex colorectal lesions: a retrospective analysis of outcomes

IntroductionEndoscopic Mucosal Resection (EMR) is a well-recognised technique for removing polyps in the gastrointestinal tract. In the South Eastern trust a pathway has been set up for dedicated endoscopy lists to facilitate removal of complex polyps which previously may have required surgical intervention. We aim to report outcomes for patients who have undergone advanced EMR in the South-Eastern Trust including complications, recurrence rates and avoidance of surgery.MethodsA retrospective review was carried out in all patients undergoing advanced polypectomy (excluding endoscopic full thickness resection) on dedicated lists in the South-Eastern Trust from October 2018 to November 2022 inclusive. Patients were identified via the Trust SharePoint dataset, theatre management system (TMS©) and the electronic care record (ECR©). All patients were discussed at the significant polyp and early colorectal cancer (SPECC) multidisciplinary team meeting pre-procedure and following results of histology with follow-up arranged as per local guidelines. Primary outcome measures included were surgical intervention rate, complications and recurrence.ResultsA total of 126 patients were identified. All had EMR, thermal coagulation of edges and appropriate defect closure post polypectomy to reduce the risk of post procedural bleeding. 36/126 (28.6%) were in the rectum. The median size of lesion was 30mm (10–93mm).78/126 (61.9%) of patients had an Over-The-Scope Clip (manufactured by OVESCO) to close the defect.6/126 (4.8%) of patients proceeded to surgical resection. 5/6 (83.3%) of these patients had R1 malignancy in their polypectomy. 4/5 (80%) had residual disease in their surgical specimen, 1/6(20%) had no residual disease but did have a lymph node positive for metastatic disease.4/126 (3.2%) had post-procedural bleeding, with 1/126 (0.8%) requiring colonoscopy for haemostasis. 117/126 (92.9%) were completed successfully as a day procedure, with 9/126(7.1%) admitted post procedure for observation. 1/126 (0.8%) was re-admitted in the days’ post -procedure but was managed conservatively following normal cross-sectional imaging.11/126(8.7%) had evidence of recurrence on their follow-up endoscopy and underwent further successful definitive EMR with all histology confirming benign disease.24/126 (19%) of patients are awaiting follow-up, and 14/126 (11.1%) have either declined follow-up or have been judged clinically too frail for endoscopic follow-up.ConclusionsEndoscopic re