TY - JOUR
T1 - Effect of referral pattern and histopathology grade on surgery for nonmalignant colorectal polyps
AU - Moon, Nabeel
AU - Aryan, Mahmoud
AU - Khan, Walid
AU - Jiang, Peter
AU - Madhok, Ishaan
AU - Wilson, Jake
AU - Ruiz, Nicole
AU - Ponniah, Sandeep A.
AU - Westerveld, Donevan R.
AU - Gupte, Anand
AU - Pooran, Nakechand
AU - Qumseya, Bashar
AU - Forsmark, Chris E.
AU - Draganov, Peter V.
AU - Yang, Dennis
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: C. E. Forsmark: Consultant for Boeringer Ingelheim; Vice Chair/Board of Director of the National Pancreas Foundation. P. V. Draganov: Consultant for Olympus, Lumendi, Boston Scientific, Cook Medical, and Microtech. D. Yang: Consultant for Steris, Boston Scientific, and Lumendi. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2020
PY - 2020/9
Y1 - 2020/9
N2 - Background and Aims: The incidence of surgery for nonmalignant colorectal polyps is rising. The aims of this study were to evaluate referral patterns to surgery for nonmalignant polyps, to compare outcomes between surgery and endoscopic resection (ER), and to identify factors associated with surgery in a university-based, tertiary care center. Methods: Patients referred to colorectal surgery (CRS) for nonmalignant colorectal polyps between 2014 and 2019 were selected from the institution's integrated data repository. Clinical characteristics were obtained through chart review. Multivariate analysis was performed to identify factors associated with surgery for nonmalignant polyps. Results: Six hundred sixty-four patients with colorectal lesions were referred to CRS, of which 315 were for nonmalignant polyps. Most referrals (69%) came from gastroenterologists. Of the 315 cases, 136 underwent surgery and 117 were referred for attempt at ER. Complete ER was achieved in 87.2% (n = 102), with polyp recurrence in 27.2% at a median of 14 months (range, 0-72). When compared with surgery, ER was associated with a lower hospitalization rate (22.2% vs 95.6%; P <.0001), shorter hospital stay (mean,.5 ±.9 vs 2.23 ± 1 days; P <.0001), and fewer adverse events (5.9% vs 22.8%; P =.0002). Intramucosal adenocarcinoma on baseline pathology (odds ratio, 5.7; 95% confidence interval, 1.2-28.2) and referrals by academic gastroenterologists (odds ratio, 2.5; 95% confidence interval, 1.11-5.72) were associated with a higher likelihood of surgery on multivariate analysis. Conclusions: Gastroenterologists commonly refer nonmalignant colorectal polyps to surgery, even though ER is effective and associated with lower morbidity. Both referrals from academic gastroenterologists and baseline pathology of intramucosal adenocarcinoma were factors associated with surgery. All colorectal polyps should be evaluated in a multidisciplinary approach to identify lesions suitable for ER before embarking in surgery.
AB - Background and Aims: The incidence of surgery for nonmalignant colorectal polyps is rising. The aims of this study were to evaluate referral patterns to surgery for nonmalignant polyps, to compare outcomes between surgery and endoscopic resection (ER), and to identify factors associated with surgery in a university-based, tertiary care center. Methods: Patients referred to colorectal surgery (CRS) for nonmalignant colorectal polyps between 2014 and 2019 were selected from the institution's integrated data repository. Clinical characteristics were obtained through chart review. Multivariate analysis was performed to identify factors associated with surgery for nonmalignant polyps. Results: Six hundred sixty-four patients with colorectal lesions were referred to CRS, of which 315 were for nonmalignant polyps. Most referrals (69%) came from gastroenterologists. Of the 315 cases, 136 underwent surgery and 117 were referred for attempt at ER. Complete ER was achieved in 87.2% (n = 102), with polyp recurrence in 27.2% at a median of 14 months (range, 0-72). When compared with surgery, ER was associated with a lower hospitalization rate (22.2% vs 95.6%; P <.0001), shorter hospital stay (mean,.5 ±.9 vs 2.23 ± 1 days; P <.0001), and fewer adverse events (5.9% vs 22.8%; P =.0002). Intramucosal adenocarcinoma on baseline pathology (odds ratio, 5.7; 95% confidence interval, 1.2-28.2) and referrals by academic gastroenterologists (odds ratio, 2.5; 95% confidence interval, 1.11-5.72) were associated with a higher likelihood of surgery on multivariate analysis. Conclusions: Gastroenterologists commonly refer nonmalignant colorectal polyps to surgery, even though ER is effective and associated with lower morbidity. Both referrals from academic gastroenterologists and baseline pathology of intramucosal adenocarcinoma were factors associated with surgery. All colorectal polyps should be evaluated in a multidisciplinary approach to identify lesions suitable for ER before embarking in surgery.
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U2 - 10.1016/j.gie.2020.04.041
DO - 10.1016/j.gie.2020.04.041
M3 - Article
C2 - 32334014
AN - SCOPUS:85087980910
SN - 0016-5107
VL - 92
SP - 702-711.e2
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 3
ER -