P4487 - The Prevalence of Large Colorectal Polyps Requiring EMR, ESD, EFTR, or Surgery Found During Screening Colonoscopy

Anna Chen, MD¹, Reeya Lele, BS², Louis Kishfy, MD¹, Huzaif Taufiq, MD³, Grace Schiavone, BA², Nevin Varghese, MD¹, Jayati Anand, BS², Chioma Nwonu, MD¹, Pranavi Nara, BS², Anh Nguyen, BS², Joria Le, RN, BSN², Alexander Schlachterman, MD², Monjur Ahmed, MD, FACG^1
1Thomas Jefferson University Hospital, Philadelphia, PA; ²Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; ³Thomas Jefferson Health, Philadelphia, PA

Introduction: With the recommendation of new guidelines to start colorectal cancer screening in average-risk individuals at age 45, gastroenterologists and colorectal surgeons are performing an increasing number of screening colonoscopies. However, certain polyps such as large flat polyps or carpet lesions may need advanced procedures such as EMR (endoscopic mucosal resection), ESD (endoscopic submucosal dissection), or EFTR (endoscopic full-thickness resection) for removal which may necessitate referral to an advanced endoscopist¹. Endoscopically unresectable or malignant polyps are also referred to surgeons for resection. This study aimed to determine the prevalence of large polyps requiring EMR, ESD, EFTR, or surgery found during screening colonoscopies.

Methods: A retrospective study was performed in which charts of patients undergoing screening colonoscopy at Thomas Jefferson University Hospital and Jefferson Methodist Hospital between November 2021-October 2024 were reviewed. Demographic information as well as polyp type, pathology, and whether advanced procedures were required were noted. Patients were excluded if the procedure was aborted due to poor prep or if their colonoscopy was not performed for purely screening purposes.

Results: A total of 2857 patients were analyzed, 299 of whom were excluded due to poor prep or the colonoscopy not being for cancer screening purposes. Out of the remaining 2558 patients, 41 required an advanced procedure (1.60%). Demographics between patients requiring and not requiring advanced procedures were similar. In patients requiring an advanced procedure, the majority (69%) underwent EMR for polyps ≥1 cm in size. In addition, the majority of polyps removed with advanced procedures were sessile (65.85%) and only 4.88% were flat. Polyps requiring advanced procedures had a higher percentage of serrated, tubulovillous, and malignant pathology.

Discussion: This study found that the percentage of patients undergoing screening colonoscopy requiring advanced procedures was relatively low. However, this population tended to have more serrated, tubulovillous, and malignant lesions. This information can help shed light on the need for further training and education regarding advanced procedures and knowing when to refer to advanced endoscopy.

References:

1. Angarita, F. A., Feinberg, A. E., Feinberg, S. M., Riddell, R. H., & McCart, J. A. (2017). Management of complex polyps of the colon and rectum. International Journal of Colorectal Disease, 33(2), 115–129.

Disclosures:


Anna Chen, MD¹, Reeya Lele, BS², Louis Kishfy, MD¹, Huzaif Taufiq, MD³, Grace Schiavone, BA², Nevin Varghese, MD¹, Jayati Anand, BS², Chioma Nwonu, MD¹, Pranavi Nara, BS², Anh Nguyen, BS², Joria Le, RN, BSN², Alexander Schlachterman, MD², Monjur Ahmed, MD, FACG¹. P4487 - The Prevalence of Large Colorectal Polyps Requiring EMR, ESD, EFTR, or Surgery Found During Screening Colonoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.