Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 39
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available at Colorectal Disease - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: A malignant polyp is a retrospective diagnosis of an endoscopically excised polyp with positive histological finding of malignancy. ACPGBI guidelines (2013) recommend follow-up endoscopy at 3 months. Our primary aim was to assess concordance with these guidelines, with the secondary aim to assess early recurrence. Methods: Retrospective analysis of all malignant polyps treated endoscopically between April 2012 and April 2015 within a regional cancer network. Results: 177 patients were identified of whom 37 underwent surgery. 140 patients underwent endoscopic surveillance with recurrence in 5 patients. Median age of observed patients was 68.5 years. 93.6% of polyps were located in the rectum or sigmoid (n = 67 and 64 respectively). Median size of excised polyps was 15 mm. Endoscopic surveillance within three months was undertaken in 86 patients (61.4%) and within six months in 116 patients (82.9%). By 12 months 125 patients (89.3%) had undergone endoscopic surveillance. 3/86 (3.5%) patients having 3-month surveillance had endoscopic abnormality which resulted in surgical intervention. Positive residual disease was identified in 2 out of these 3 patients. 3 recurrences were identified late (>3 months) with two on cross sectional imaging (6 and 12 months respectively), and one on endoscopy at 12 months. A normal endoscopy at 3 months provided a negative predictive value of 96.4% for disease recurrence. Conclusion: A normal endoscopy at three months excluded the risk of recurrence/ residual disease for the vast majority of patients, however less than 2/3 patients with malignant polyps are appropriately followed up with a three-month endoscopy as per the ACPGBI guidelines.