PWE-124 Complex Colorectal Polyps: A Tertiary Centre Experience; Tailoring The EMR Technique to ThePolyp

Introduction Features that characterise polyp complexity should be clearly defined and recognised to avert suboptimal piecemeal endoscopic mucosal resection (p-EMR) strategies and need for salvage surgery. Methods A prospective database of all colorectal polyps excised at our tertiary referral centre between Jan 2010 and August 2012 was collected. Standard p-EMR, p-EMR using a 20 mm spiral snare (sp-EMR), and hybrid p-EMR (hp-EMR; p-EMR plus endoscopic mucosal ablation or endoscopic submucosal dissection) were performed. Multinomial regression analysis was utilised to define characteristic features of complex polyps and factors associated with the chosen resection technique. Results Of 330 patients with 341 polyps (mean size 3.7 cm), 81% (261/323, p i) tertiary referrals (sp-EMR, OR 3.41, p ), ii) incomplete polyp lift (hp-EMR, OR 8.3 > sp-EMR, OR 1.19 p iii) previous polypectomy attempt (hp-EMR, OR 2.77, p = 0.02), iv) larger polyp size (for an increase of 1 cm – hp-EMR (OR 1.37)/sp-EMR (OR 1.66,) p v) polyps in the rectosigmoid location (sp-EMR and hp-EMR, p vi) Paris IIa+IIb polyps (sp-EMR, OR 5.01 and hp-EMR, OR 2.9, p –0.007). Conclusion Complex colorectal polyps referred to this tertiary centre were characterised by polyp size ≥ 4 cm, caecal location, previous unsuccessful polypectomy, difficult endoscopic access, or incomplete polyp lift. Advanced techniques such as hybrid-pEMR and spiral p-EMR were required in 33% of tertiary referrals. Disclosure of Interest None Declared