A108 A RETROSPECTIVE REVIEW OF COMPLEX POLYP MANAGEMENT IN THE CHAMPLAIN REGION, ONTARIO

Abstract

BackgroundAdvanced endoscopic techniques have enabled the removal of polyps which, due to their size, location, or morphology, would otherwise have been removed surgically. Patients with such complex polyps should be referred promptly to expert centres for adjudication and management.AimsTo review patterns of referral and initial management of complex polyps at The Ottawa Hospital (TOH), to identify gaps in care and to identify strategies to address those gaps.MethodsWe performed a retrospective chart review of cases where large (>3cm) colonic polyps were evaluated at TOH, from March 2019-March 2021. Cases were identified using Canadian Institute of Health Information codes. Descriptive statistics were analyzed, and were compared using Mann-Whitney U tests where appropriate.Results94 consecutive patients with large polyps (mean age 68; 56.4% male) were included. The average polyp size was 4.7(4.4–5.1)cm. 45 patients were referred for a known complex polyp while the rest were referred for FIT/FOBT+ (n=20), symptoms or anemia (n=17), surveillance (n=9), or abnormal imaging (n=3). 32 patients were referred from >50km from Ottawa (travelling), and 62 were referred from <50km from Ottawa (local). Of the 45 referrals for known polyp, 20 (44.4%) included photodocumentation of the lesion; 33 (73.3%) had a prior biopsy, and 8 (17.8%) were partially removed. Key statistics are summarized in Table 1. All 8 patients referred with a partially removed polyp eventually had a successful endoscopic polypectomy. 10/94 (10.6%) patients required surgical resection: 7 for malignant pathology, and 3 for endoscopic failure. Overall, 3 patients had post-polypectomy bleeding, and 1 patient sustained a full-thickness perforation. As of October 2021, 26/78 (33.3%) patients eligible for a 4–6 month recheck and 36/48 (75%) patients eligible for a 12-month follow-up colonoscopy were overdue.ConclusionsThis retrospective review highlights significant differences in the management of complex polyps based on patient geography and the need to develop strategies to improve access for patients referred from outside of Ottawa. As expected, COVID had a significant impact on the time to complete removal of polyps, and affected the timely endoscopic follow up of these high-risk patients. Strategies to ensure timely endoscopic follow up of patients after complex polyp removal are needed.Table 1. Number of procedures and time to complete polyp removal based on patient geography, prior polyp management and COVID lockdownMean # Procedures to Complete Removalp=Mean # Removal Attemptsp=Time from Detection to Complete Removal (days)p=All Cases (n=94)2.071.1998Travelling Pts (n=32)2.48<0.011.440.0361270.022Local Pts (n=62)1.981.0794Travelling Pts Known Polyp w/ (n=22)2.64<0.011.50<0.01138NSLocal Pts w/ Known Polyp (n=23)2.351.2298Partially Removed Polyp (n=8)2.75NSKnown Polyp, Not Partially Removed (n=37)2.41Pre-COVID Lockdown (n=29)860.013During COVID Lockdown (n=58)115Funding AgenciesNone