Management of complex colonic polyps in the English Bowel Cancer Screening Programme

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Endoscopy

Background:

• Large sessile or flat colonic polyps (≥20 mm) pose challenges for endoscopic treatment and may contain malignancy.
• Optimal management strategies for these polyps are not well-defined.

Purpose of the Study:

• To describe the current management of large sessile or flat colonic polyps.
• To provide insights into optimal management strategies.

Main Methods:

• Retrospective observational study of patients with large sessile or flat polyps in the English Bowel Cancer Screening Programme (2006-2009).
• Analysis of initial management (surgical vs. endoscopic), subsequent treatments, and outcomes including malignancy, need for surgery, complications, and recurrence at 12 months.

Main Results:

• 557 large polyps were identified. 78.3% were initially managed endoscopically, 21.7% surgically.
• 19.3% of endoscopically managed polyps required subsequent surgery due to malignancy or unsuitability for further endoscopic treatment.
• Recurrence or residual polyp occurred in 6.0% of endoscopically treated patients. Significant variation in primary surgical rates (7-36%) was observed between centers. Endoscopic complications included bleeding (3.0%) and perforation (0.5%).

Conclusions:

• Current management of large sessile or flat colonic polyps within the English Bowel Cancer Screening Programme is safe and effective.
• Significant inter-center variability in surgical intervention underscores the need for standardized management algorithms.