Mo1652 SMALL POLYP (6-9 MM) RESECTION: ADOPTION OF OPTIMAL TECHNIQUE OVER TIME

Abstract

Cold snare technique has emerged as the optimal technique for removal of small (6-9 mm) polyps to avoid incomplete resection (associated with cold biopsy resection) and bleeding/perforation complications (associated with hot snare technique). Describe small polyp (6-9 mm) resection technique from 2012 to 2019. We conducted a single center retrospective study at an academic Veterans Affairs Medical Center including colonoscopies performed between 2012-2019 where a polyp 6-9 mm was removed. Procedures were performed by board certified gastroenterologists and surgeons. Chart review was performed to collect patient characteristics, procedure findings, polypectomy technique and pathology results. Resection techniques over time are displayed overall as well as stratified by different specialties and level of experience. Monotonic trends over time were examined using the Mann-Kendall test and the resulting p-values and tau test statistics are provided. Seventeen gastroenterologists and four surgeons performed 773 procedures where a 6-9 mm polyp was removed. There was a significant increase in cold snare use from 2012-2019 overall (tau 0.86, p=0.004) and individually for both specialties (GI: tau 0.64, p=0.035; surgery: tau 0.90, p=0.007) (table). There was a sharp increase in cold snare use among gastroenterologists from 2015 (72.0%) to 2016 (97.1%) and remained over 95% thereafter. For surgeons, there was a sharp increase in cold snare use from 2016 (75.9%) to 2017 (90.9%) and remained over 90% thereafter. From 2017 and onward, zero 6-9 mm polyps were removed with a cold forceps by gastroenterologists. Trainee involvement in procedures followed similar trends of improved practice over time (figure). Over time, there was significant improvement in adoption of cold snare resection for 6-9 mm polyps by both gastroenterologists and surgeons. Gastroenterologists appeared to adopt optimal practice earlier than surgeons and have had a longer standing zero-tolerance use of cold biopsy forceps for these polyps compared to surgeons. Although encouraging that all endoscopists are adopting optimal technique, delayed uptake based on specialty emphasizes the importance of standardizing continuing education and quality assurance across specialties.Trend in polyps removed using the different resection techniques overtime. For each year the proportion of polyps removed using a given resection technique are displayed as % (N). These results are displayed overall as well as stratified by different specialties and level of experience. Monotonic trends overtime were evaluated using the Mann-Kendall test and specialty groups with significant trends are displayed with corresponding asterisks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)