P296 Operational outcomes of a modern complex polyp MDM

IntroductionGiven the advances in endoscopic imaging and polypectomy techniques more complex polyps are deemed appropriate for endoscopic resection. BSG recommends that patients with benign NPCPs (Non-pedunculated colorectal polyps) should not undergo surgery without a discussion in a multidisciplinary meeting (MDM) setting.MethodsOur modern Complex Polyp MDM (CP-MDM) comprises 2 gastroenterologists and 2 colorectal surgeons all competent in advanced polypectomy, a complex polyp fellow, 2 staff grade trainees, 1 paediatrician endoscopist, a histopathologist, Complex polyp specialist nurse, BCS nurses, nurse endoscopists, on demand radiologist and an CP-MDM Coordinator. All patients are pre-assessed and have post procedure follow up by the complex polyp nurse. During the CP-MDM all the new cases are discussed and a management plan is formulated, based on the endoscopist’s competency. The final CP-MDM outcomes were retrieved from the electronic database where all referrals and outcomes are published. With the aid of designated online referral as a part of a high operational policy, the source of referrals, and the timeframe of the proposed therapeutic management were recorded. Additionally, we monitored the operational impact on the service (pathway dependent) and the reasons for the need of repeated discussions.ResultsWe retrospectively reviewed data from Jan 2020 to Jan 2022 from our CP-MDM cohort. Over the three-year period we received 1,311 new referrals. Approximately, 51% (668) from cancer pathway, 19.6% (257) from Bowel cancer screening, 7.2% (95) as urgent, 22% (289) as routine and 0.15% (2) from the colorectal MDM. Patients deemed not complex 4.8% (64). The remaining cases were scheduled within the time frame 71.5% (937) while 24.5% (322) were booked with minor delays due to current hospital pressures. The number of patients upgraded to the Cancer Pathway 1.7% (23) and the cases downgraded from the Cancer Pathway were 18% (237). While 79.3% of the cases went directly to have therapeutic endoscopy, 20.7% cases required further discussion. The reasons for repeat discussions were; the need for endoscopic reassessment in 4.8% (63), histology not ready 6.8% (90), awaiting further investigations 3.4% (45) and joint clinic with gastroenterologist/surgeon consultation on a dedicated complex polyp clinic 0.9% (12).ConclusionA modern CP-MDM appears to be the foundation for the management of complex polyps when a clinical governance framework is formulated. Fu