Polypectomy at colonoscopy and sigmoidoscopy in England: a review of national data between 1997 and 2007

Introduction Currently, there is no national endoscopic database in England. Information regarding the volume of therapeutic endoscopic procedures such as polypectomy is obtained mainly from small prospective studies. This article examines the Hospital Episode Statistics (HES) database to assess the number of patients that have undergone a therapeutic polypectomy for a diagnosis of a benign colorectal polyp over a 10-year period. We also analyse 28-day re-admission and 30-day mortality rates post procedure across 174 English National Health Service (NHS) units. Methods All elective patients having undergone a therapeutic polypectomy for a benign colorectal polyp between 1 Jan 1997 and 31 December 2007 in English NHS units were identified from HES after cleaning and formatting the dataset. Trends in rates of colonoscopies and flexible sigmoidoscopies were evaluated as well as 28-day re-admission and mortality rates over time. The reliability of HES data has previously been demonstrated in general surgical and medical patient cohorts Results The HES dataset reports that, 334,753 polypectomy procedures were performed on 286,204 patients in English NHS Trusts over the 10-year period. Of these, 233,119 (69.6%) were colonoscopicand 101,634 (30.4%) were via flexible sigmoidoscopy. Over this period a 55.2% increase in the total number of endoscopic polypectomy procedures were performed (from 20,289 in 1997 to 31,503 in 2007). Over the study years, the unadjusted average readmission (range-2.08% > 2.47%) and mortality rates (range −0.33% > 0.63%) overall were not significantly different (p = 0.440, both). Table 1 OC-080 YEAR Readmission rate (%) Mortality Rate (%) Number of procedures 1997 2.188 0.3 20289 1998 2.19 0.33 27262 2000 2.119 0.24 33505 2001 2.311 0.09 33235 2003 2.328 0.18 38021 2004 2.204 0.25 28398 2005 2.345 0.08 25881 2006 2.479 0.1 28927 2007 2.454 0.06 31503 Conclusion This analysis is the first to report national lower GI polypectomy numbers. It appears to demonstrates that patients undergoing endoscopic polypectomy rose by 55% from 1997 to 2007. Improved coding and a genuine increase in polypectomy workload may underlie these findings. Given the volumes of polypectomies being undertaken, and that polypectomy accounts for most of the procedure related risk with lower GI endoscopy, this may strengthen the case for improved training and accreditation in polypectomy.