Management of Large Polyps in a French Colorectal Cancer Screening Program Using Fecal Immunochemical Testing Suboptimal, With Widely Varying Endoscopic Resection Rates
Douglas K. Rex, MD, MASGE, reviewing Denis B, et al. Endosc Int Open 2021 Nov.
In a study of fecal immunochemical test-positive patients in France, 1256 large polyps (LPs), defined as polyps ≥20 mm, were detected by 102 community gastroenterologists. The endoscopic resection rates were 70.2% for nonpedunculated and 95.2% for pedunculated benign polyps; rates varied among endoscopists, ranging from 0% to 100%. Endoscopic resection correlated with cecal intubation and adenoma detection rates. There were 183 surgeries for benign LPs, of which most, and arguably all, were unwarranted. Endoscopic submucosal dissection was used sparingly, with 22 needed to avoid 1 surgery.
COMMENTThese results are disappointing but may be similar in the United States given the large number of patients referred to surgical resection of benign colon polyps. Some previous studies have found that the quality of endoscopic resection and detection were not correlated, but the current study suggests that some community colonoscopists are ineffective at insertion, detection, and resection.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Denis B, Gendre I, Perrin P, Tuzin N, Pioche M. Management of large polyps in a colorectal cancer screening program with fecal immunochemical test: a community- and population-based observational study. Endosc Int Open 2021;9:E1649-E1657. (https://doi.org/10.1055/a-1551-3306)
