The impact of a multidisciplinary team approach on the management of patients diagnosed with complex colorectal polyps.

Abstract

Aim: Large nonpedunculated colorectal polyps (LNPCPs) have a greater than average risk of malignancy, incomplete resection/recurrence and complications associated with treatment. Appropriate management of these lesions is crucial to prevent cancer and reduce harm. The British Society of Gastroenterologists (BSG) and the Association of Coloproctologists of Great Britain and Ireland (ACPGBI) published guidelines for the management of LNPCPs in 2015. The aim of this work was to evaluate the case mix and outcomes from a single centre's multidisciplinary approach to managing such lesions against the key performance indicators (KPIs) set within these national guidelines.

Method: Cohort study from a single centre over a 2-year period, January 2020 to December 2022.

Results: After exclusions, a total of 229 cases were discussed. Most complex polyps were treated endoscopically, with conservative management recommended in 22 cases where patients had significant comorbidities and were unlikely to benefit from therapy. The overall surgical intervention rate (including transanal endoscopic microsurgery/per anal excision) was 14%. Of the cases treated endoscopically, there was residual polyp detected in 3.9% at 12-months' follow-up. Complications were rare. There was a single case of perforation following endoscopic submucosal dissection and no significant postprocedure bleeds. There were no perforations following endoscopic mucosal resection, although postpolypectomy bleeding requiring admission occurred in 4%. Sixty-eight per cent of patients were treated within 56 days of multidisciplinary team (MDT) discussion, despite the timeframe being within a period of huge disruption due to the global COVID pandemic. KPI standards published by the BSG were therefore met.

Conclusion: MDT management of complex polyps (LNPCPs) is effective and meets the standards set by national guidance. Patient outcomes following treatment for complex polypectomy are improved when the most appropriate procedure is performed by the most appropriate operator. Discussion at a complex polyp MDT can facilitate this approach.