Polyps seen but not removed during index colonoscopy: an underestimated inefficiency in endoscopy practice

Post written by Krish Ragunath, MD, from the NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.


The aim of this study was to evaluate the practice of nonremoval of polyps at index endoscopy and to try and elucidate the potential reasons for this practice.

When small polyps are not removed at index endoscopy, a further endoscopy and a polypectomy need to be organized. This has implications on the efficient running of the endoscopy department as well as inconvenience for patients. In addition, when this practice occurs with no clear reason, it raises the question of whether there is an underlying training need or system failure.

This study was conducted at a large tertiary referral center with expertise in colorectal polypectomy, including endoscopic submucosal dissection. Despite this, our study highlighted that polyps were not resected in 7.8% of procedures where a polyp 20 mm or smaller was diagnosed without contraindication to removal. The repeat procedures required to treat the detected polyps accounted for 9.3 days of endoscopy capacity, and resultant delay in treatment was 55 days on average.

In addition, 18 patients were lost to follow-up with resection of polyps not undertaken. This practice was more commonly seen among nonphysician endoscopists. This phenomenon was even more pronounced when overestimation of polyp size and modifiable factors such as anticoagulation were taken into account.

In conclusion, identification of practitioners who have a tendency to not remove polyps and the delivery of training and support are likely to help improve endoscopy services.

Ragunath_figureA histogram showing reported polyp sizes.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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