Implementation of BSG/ACPGBI/PHE polypectomy surveillance guidelines safely reduces the burden of surveillance in a screening cohort: a virtual model study

Roisin Stack; Jayne Doherty; Neil O'Moráin; Blathnaid Nolan; Juliette Sheridan; Garret Cullen; Hugh Mulcahy; Maire Buckley; Gareth Horgan; Mohamed Hamed; Edel McDermott; Glen Doherty

doi:10.1136/bmjgast-2023-001160

Implementation of BSG/ACPGBI/PHE polypectomy surveillance guidelines safely reduces the burden of surveillance in a screening cohort: a virtual model study

BMJ Open Gastroenterol. 2023 Sep;10(1):e001160. doi: 10.1136/bmjgast-2023-001160.

Authors

Roisin Stack^{1

2}, Jayne Doherty^{3

2}, Neil O'Moráin^{3

2}, Blathnaid Nolan³, Juliette Sheridan³, Garret Cullen^{3

2}, Hugh Mulcahy^{3

2}, Maire Buckley³, Gareth Horgan³, Mohamed Hamed³, Edel McDermott³, Glen Doherty^{3

2}

Affiliations

¹ Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland stack.roisin@gmail.com.
² School of Medicine, University College Dublin, Dublin, Ireland.
³ Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.

Abstract

Objective: To evaluate the impact of British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE) 2019 polypectomy surveillance guidelines within a national faecal immunochemical test-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application.

Design: A retrospective review of BS colonoscopies performed in 2015-2016 with 5 years prospective follow-up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG/ACPGBI/PHE 2019 guidelines and compared with pre-existing 'European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis' (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG/ACPGBI/PHE 2019 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed.

Results: Total number of index BS colonoscopies performed in 2015-2016 inclusive was 890. 115 were excluded (22 no caecal intubation, 51 inadequate bowel preparation, 56 incomplete polyp clearance). N=509 colonoscopies were scheduled within a 5-year interval following index colonoscopy surveillance rounds based on EUQA guidelines. Overall, volume of surveillance was significantly reduced with retrospective application of BSG/ACPGBI/PHE 2019 guidelines (n=221, p<0.0001). No cancers were detected within the 'potentially deferred' procedures who attended for follow-up (n=330) with high-risk findings found in<10% (n=30) of colonoscopies within the BSG/ACPGBI/PHE cohort.

Conclusion: BSG/ACPGBI/PHE 2019 guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.

Keywords: COLORECTAL CANCER SCREENING; ENDOSCOPY; POLYP.

MeSH terms

Colonoscopy*
England
Gastroenterology*
Humans
Prospective Studies
Retrospective Studies