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Khalaf K, Seleq S, Bourke MJ, Alkandari A, Bapaye A, Bechara R, Calo NC, Fedorov ED, Hassan C, Kalauz M, Kandel GP, Matsuda T, May GR, Mönkemüller K, Mosko JD, Ohno A, Pavic T, Pellisé M, Raos Z, Repici A, Rex DK, Saxena P, Schauer C, Sethi A, Sharma P, Shaukat A, Siddiqui UD, Singh R, Smith LA, Tanabe M, Teshima CW, von Renteln D, Gimpaya N, Pawlak KM, Angeli Fujiyoshi MR, Fujiyoshi Y, Lamba M, Li S, Malipatil SB, Grover SC. Establishment of standards for the referral of large nonpedunculated colorectal polyps: an international expert consensus using a modified Delphi process. Gastrointest Endosc 2024; 100:510-516.e6. [PMID: 38331224 DOI: 10.1016/j.gie.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND AIMS Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large nonpedunculated colorectal polyps are often referred to expert centers for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of this study was to establish minimum expected standards for the referral of large nonpedunculated colonic polyps for potential endoscopic resection. METHODS A Delphi method was used to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and 3 rounds of surveys were conducted to achieve consensus. Quantitative and qualitative data were analyzed for each round. RESULTS A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographic characteristics, relevant medications, lesion factors, photodocumentation, and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements, which were scored on a scale of 1 to 10, ranged from 7.04 to 9.29, with high percentages of experts considering most statements as a very high priority. Subgroup analysis according to continent revealed some variations in consensus rates among experts from different regions. CONCLUSIONS The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.
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Affiliation(s)
- Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Samir Seleq
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Michael J Bourke
- Westmead Hospital University of Sydney, Sydney, New South Wales, Australia
| | - Asma Alkandari
- Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait City, Kuwait
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Robert Bechara
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Natalia C Calo
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Evgeniy D Fedorov
- Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Mirjana Kalauz
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Gabor P Kandel
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Gary R May
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Klaus Mönkemüller
- Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jeffrey D Mosko
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Akiko Ohno
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tajana Pavic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Maria Pellisé
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Zoe Raos
- Department of Gastroenterology, Te Whatu Ora-Waitemata, Faculty of Medicine, The University of Auckland, Auckland, New Zealand
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Cameron Schauer
- Department of Gastroenterology, Te Whatu Ora-Waitemata, Faculty of Medicine, The University of Auckland, Auckland, New Zealand
| | - Amrita Sethi
- Division of Digestive and Liver Disease, Irving Medical Center, Columbia University, New York, New York, USA
| | - Prateek Sharma
- University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York City, New York, USA
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA
| | - Rajvinder Singh
- Lyell McEwin Hospital, NALHN & the University of Adelaide, Adelaide, South Australia, Australia
| | - Lesley-Ann Smith
- Department of Gastroenterology, Te Whatu Ora-Waitemata, Faculty of Medicine, The University of Auckland, Auckland, New Zealand
| | - Mayo Tanabe
- Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan
| | - Christopher W Teshima
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Daniel von Renteln
- Centre Hospitalier de l'Universite de Montreal (CHUM), Universite de Montreal, Montreal, Quebec, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Mary Raina Angeli Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Yusuke Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Mehul Lamba
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Suqing Li
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharan B Malipatil
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada; Scarborough Health Network, Toronto, Ontario, Canada.
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Liu E, McDonald C, Son S, Hawel J, Hussain N, Khanna N, Yan B, Jairath V, Sey M. Extended delay in endoscopic mucosal resection is not associated with adverse outcomes: Findings from the COVID-19 pandemic. Endosc Int Open 2023; 11:E474-E479. [PMID: 37180309 PMCID: PMC10169224 DOI: 10.1055/a-2048-1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/02/2023] [Indexed: 05/16/2023] Open
Abstract
Abstract
Background and study aims The aim of this study was to investigate the impact of delayed endoscopic mucosal resection (EMR) of colorectal polyps on health outcomes.
Patients and methods A bidirectional cohort study was completed. A baseline group consisting of all EMRs performed within a 15-month period before a province-wide, government-mandated cessation of EMR procedures due to the global pandemic was compared to EMRs impacted by the shutdown, defined as the COVID-19-delayed group. The primary outcome was the incidence of malignant polyps. Secondary outcomes included technical success, polyp recurrence at follow-up colonoscopy, advanced polyp histology, probability of meeting endoscopic criteria for adequate resection for malignant polyps, metastatic colorectal cancer, and complications.
Results A total of 268 EMR procedures were included in the study cohort, of which 208 formed the baseline group and 60 were in the COVID-19-delayed group. The median (IQR) patient age was 72 (13.0) and 113 (41.2 %) were females. The median (IQR) wait time was 92 days (87.8) in the baseline group and 191 days (127.8) in the COVID-19-delayed group (P < 0.001). Overall, there were no significant differences in the incidence of malignant polyps, technical success, polyp recurrence on follow-up colonoscopy, advanced polyp histology, adequate endoscopic resection for malignant polyps, metastatic colorectal cancer, or complications between the two groups (P > 0.05 for all outcomes).
Conclusions A longer wait time for EMR of colorectal polyps, increasing from a median of 92 to 191 days, was not associated with worse outcomes.
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Affiliation(s)
- Eddie Liu
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Cassandra McDonald
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Surim Son
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeffrey Hawel
- Division of General Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Nadeem Hussain
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Nitin Khanna
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Brian Yan
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Vipul Jairath
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Sey
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
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