Practice Patterns of Polyp Assessment During Colonoscopy: An International Cross-Sectional Analysis

Aims Colonoscopy has been established as the gold standard for colorectal cancer screening and diagnosis, with its capacity to detect and remove precancerous polyps. However, there remains substantial variability in the assessment of polyps during colonoscopy, particularly within the Gulf region, where limited data exist regarding evidence-based guidelines for polyp detection, assessment, and management. The primary aim of this study is to evaluate the practice patterns of endoscopists regarding polyp evaluation during colonoscopy. The secondary aims are to identify factors that influence endoscopist’s polyp assessment and endoscopic tattoo practices.

Methods A 21-question self-administered survey was distributed amongst physicians who perform colonoscopy by using an electronic cloud-based survey tool. Statistical analysis was performed to evaluate factors affecting endoscopist’s practice patterns and to assess the level of adherence to current consensus recommendation.

Results A total of 102 physicians participated in the survey, with the majority being male (80.21%) and having a mean of 11.53±10.28 years of independent practice in performing colonoscopies. Among the participants, 87.25% (n=89) were gastroenterologists, 6.86% (n=7) gastroenterology trainees, 4.9% (n=5) surgeons, and 0.98% (n=1) general practitioners. Approximately half of the participants worked in academic settings (49.02%, n=50), while the other half practiced in non-academic settings (50.98%, n=52). Polyps exhibiting high-risk features suggestive of deeper invasion were the predominant referral criteria to advanced endoscopists for advanced resection, recognized by 58.51% (n=55/94) of participants. Anatomically challenging locations of polyps was the second most prevalent reason for referral, acknowledged by 35.11% (n=33/94) respondents, followed by large polyps greater than 20 mm, selected by 32.98% (n=31/94) respondents. The predominant reason advocating for surgical referral was the presence of high-risk features indicative of deep invasion, chosen by 60.78% (n=62/102) respondents. There is a wide variation in the frequency of utilization for various advanced endoscopic imaging and classification modalities amongst clinicians. Regarding tattoos, transverse, sigmoid and descending colon were the most frequent sites for tattoo placement (21.2%, n=52; 20%, n=49; 19.6%, n=48, respectively). The cecum and rectum were less favored sites for tattoo placement (8.2%, n=20; 6.1%, n=15, respectively). Interestingly, a notable proportion, represented by 5.7% respondents (n=14) indicated that they would not place a tattoo in any segment. [1] [2] [3]

Conclusions Overall, gastroenterologists appear more inclined to refer polyps to advanced endoscopists for endoscopic resection compared to surgeons who preferred surgical resection. Tattoo practices and endoscopic imaging utilization also varied greatly amongst endoscopists. This study emphasizes the importance of implementing educational programs aimed at standardizing the clinical approach to polyps.

Publication History

Article published online:
15 April 2024

• References

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