Arun Rajendran

PTH-039 Prevalence of sessile serrated adenomas/polyps in distal colon during screening colonoscopy/flexible sigmoidoscopy: a single bowel cancer screening experience from uk

Introduction Sessile Serrated Adenomas/Polyps (SSA/P) are responsible for nearly 20% of colo rectal cancer (CRC). Despite the utility of novel image enhancing techniques including narrow band imaging it is difficult to differentiate hyperplastic (HP) polyps from SSA/Ps. Vast proportion of endoscopists leave the diminutive and possibly small HP polyps in situ in the recto sigmoid area (diagnose and disregard approach). Hence there is a possibility of leaving SSA/P in the recto sigmoid region which could potentially lead to CRC later in life. Aim To estimate the prevalence of SSA/P in recto sigmoid colon at screening colonoscopy and flexible sigmoidoscopy (FS). Method Patients aged >55 years underwent a screening colonoscopy (n=500) or a flexible sigmoidoscopy (n=500) at our institution between August 2014 and April 2015 were included. Data collected from 500 consecutive patients who underwent a colonoscopy or a FS. Demographic, procedural and polyp data were retrieved from our endoscopy database. Abstract PTH-039 Figure 1 Results 99.6% of (498/500) colonoscopy and 97.6% of flexible sigmoidoscopy procedures were completed. Screening colonoscopy detected 1006 polyps and FS detected 249 polyps. Polyp size ranged between 1–80 mm (colonoscopy mean size 6 mm, SD 7.2 mm; FS mean 3.4 mm, SD 3.9 mm). While colonoscopy detected 43 SSA/Ps (4.3%), FS detected only 6 SSA/Ps (2.4%) which equates to an overall prevalence of 3.9% (49/1255). Image 1 summarises the SSA/Ps prevalence by colonic segment. In recto sigmoid there were 21 SSA/Ps detected and resected which equals to a 3.9% of all recto sigmoid polyps. All SSA/Ps detected in this segment were less than 10 mm in size (range 2–10 mm). Only one of the SSA/P had dysplasia (4.7%). Prevalence of SSA/Ps in proximal colon was 4.8%. Conclusion Our cohort showed a slightly higher prevalence of SSA/Ps in rectum and sigmoid colon. Therefore, it becomes clinically relevant to differentiate SSA/Ps from HP polyps in recto sigmoid before adapting a diagnose and disregard approach for small (<9 mm) hyperplastic looking polyps in this location. Disclosure of Interest None Declared

OC-085 Lower Gastrointestinal Polypectomy Competencies in the UK: Retrospective Analysis

Introduction The Directly Observed Polypectomy Skills (DOPyS) is a validated tool used to assess polypectomy skills in the UK.1 The overall competency for polypectomy is graded on a scale of 1 to 4 and is used to certify trainees for level 1 polypectomy (size < 1 cm) and level 2 polypectomy (size 0–2 cm). Trainees are certified as competent if they achieve grades 3 or 4 for more than 90% in their last 4 consecutive DOPyS and a caecal intubation rate (CIR) >90% over last 3 months. The aim of the study was to investigate the progress of competency in polypectomy for endoscopy Methods Retrospective data from the e-portfolio from Jan 2009 to Sept 2015 was extracted using pre-determined criteria. 749 DOPyS data from 61 trainees was analysed. 42 trainees had achieved provisional (level 1 polypectomy) certification and 19 trainees in the same cohort subsequently achieved full (level 2 polypectomy) certification. Data collected included time (in days) & number of lower GI procedures to the start of first recorded polypectomy assessment (1 st DOPyS), time in days needed to achieve level 1 & level 2 competency from 1st DOPyS & from the first recorded lower GI procedure, caecal intubation rate (CIR) at time of 1st DOPyS & at last recorded DOPyS before certification. ResultsAbstract OC-085 Table 1 Median n Time to 1 st DOPyS (days) 449 (0–2585) 61 Lower GI endoscopic procedures at 1 st DOPyS 137 (5–508) 61 CIR at 1 st DOPyS (%) 73 (0–100) 61 Time to level 1 competency from 1 st DOPyS (days) 494 (144–1404) 42 Time to level 2 competency from 1 st DOPyS (days) 616 (228–1324) 19 Time from level 1 to level 2 competency (days) 203 (0–734) 19 CIR at last DOPyS before provisional certification (%) 86 (47–94) 42 CIR at last DOPyS before full certification (%) 88 (60–93) 19 Conclusion Trainees in the UK start formative assessment for polypectomy after > 130 lower GI procedures & CIR of >70% Median time for trainees to achieve level 1 & level 2 competencies from 1st DOPyS is < 2 years Median time for trainees to achieve level 1 competency from first recorded lower GI procedure is > 3 years Time to progress to level 2 competency from level 1 competency is > 200 days & may correspond to the rarity of polyps > 1cm in training cases Polypectomy competency in this cohort of UK trainees is achieved after reaching an overall CIR >85% Further studies are needed to analyse the learning curve of polypectomy & to implement changes to improve efficiency of training Reference 1 Gupta S, Bassett P, Man R, Suzuki N, Vance ME, Thomas-Gibson S. Validation of anovel method for assessing competency in polypectomy. Gastrointest Endosc 2012;75(3):568–575.e1. Disclosure of Interest None Declared

PTH-116 Time to Achieve Competency in Lower Gastrointestinal Polypectomy in The United Kingdom, A Retrospective Analysis

Introduction Directly Observed Polypectomy Skills (DOPyS) is a validated tool used to assess polypectomy skills in the UK. The overall competency for polypectomy is graded on a scale of 1 to 4 and is used to certify trainees for level 1 polypectomy (size < 1 cm) & level 2 polypectomy (size 1–2 cm). Trainees are certified as competent if they achieve grades 3 or 4 for more than 90% of their last 4 consecutive DOPyS. We aimed to analyse time required for a trainee to progress from DOPyS score 1 to 4Abstract PTH-116 Figure 1 Methods Retrospective data from the e-portfolio of 707 (4965 DOPyS) trainees from Jan 2009 to Sept 2015 was examined. A dataset of 24 trainees who had documented DOPyS overall score of 1 (CS1), 2 (CS2), 3 (CS3) and 4 (CS4) was recovered. For the purpose of the analysis only those trainees (n = 8) who started out at CS1 were included. 16 were excluded from analysis as they started at a higher level. Primary outcome was number of days taken by each trainee to reach the competency levels (i.e. CS2, CS3 and CS4). The proportion of trainees reaching each level was examined using Kaplan-Meier analysis to show the proportion reaching this level over time. Time taken for 25%, 50% and 75% of trainees to reach the desired level was calculated. Results Table shows time taken for 25%, 50% and 75% of trainees to reach each of the levels. The results show 50% reach CS2 after 91 days and CS3 after 112 days. It took 191 days for half of trainees to reach level CS4.Abstract PTH-116 Table 1 Level Days for 25% to reach level Days for 50% to reach level Days for 75% to reach level CS2 14 91 127 CS3 28 112 178 CS4 126 191 324 Conclusion 75% of trainees analysed reach an overall competency of 4 in 324 days. In the UK DOPyS score 3 or 4 are required to start applying for provisional/full certification and in our cohort 75% of trainees analysed achieved it in a time frame of 6 months to a year. Further prospective studies analysing time taken, procedure numbers & associated factors are needed to assess the learning curve for polypectomy & implement changes to improve efficiency in training Limitation The retrospective data and the small numbers are the limitations of the study Disclosure of Interest None Declared

OC-047 A multi disciplinary team (mdt) approach for complex benign colo rectal polyps: a tertiary referral centre experience

Introduction Multi-disciplinary team (MDT) working is an established part of cancer care. Limited data is available on their impact for benign complex colorectal polyps. Increased numbers of these polyps are referred to our tertiary centre for further management. Method Polyp MDT comprising of gastroenterologists, colorectal surgeons and histopathologists was established in January 2013 to discuss the management of complex polyps (large or recurrent polyps or those where endoscopic access was difficult). Cases that were referred to individual consultants and had a provisional management plan made were then discussed at the MDT and a consensus management plan was agreed. The impact of MDT management plan was then evaluated. Results 96 cases were discussed between January 2013 and October 2014. Of those 75 (78%) were tertiary referrals. The reasons for polyp complexity included large polyps 53 (55%), those with difficult access 52 (54%) and previous failed attempt 35 (36%). Majority of the polyps were in recto sigmoid, 49 (51%) or in caecum, 32 (32%). In 38 cases (40%) provisional management plan was changed after MDT discussion. This plan was then followed in 80/96 (82%) cases. Combined surgical-endoscopic approaches were proposed in 68 cases (65%). 25/96 patients had polypectomy during a single hospital visit. The remaining cases (71/96) needed further assessment before attempted polypectomy. Complete polypectomy was achieved in 85/96 (89%) of patients: endoscopically in 75/96 cases (78%): 38 by endoscopic excision alone and 37 by combined endo-surgical approaches. Ten polyps were resected surgically. Of the remaining 11 patients no polyps were found in 2 of those referred, 2 patients were referred back their local hospital for surgery, 5 were not fit for a polypectomy and are under surveillance, 1 had metastatic colorectal cancer and 1 declined any intervention. Cancer was found in 7/96 polyps and 6/7 had surgical resection (the remaining patient had metastatic disease). Conclusion The polyp MDT consensus management plan led to a change in the proposed management in almost half of the patients. This resulted in complete polypectomy for a large majority of patients referred to our service. Disclosure of interest None Declared.

PTH-040 Laparoscopic-assisted colonoscopic polypectomy is a safe and effective option for difficult polyps: a single tertiary referral centre experience

Introduction Colonic polyps deemed difficult to access or resect at endoscopy are often referred for surgical resection. We report our experience using laparoscopic assisted colonoscopic polyp resection at a single tertiary referral centre. Method Combined procedures from 2012 to 2014 for patients referred for resection of colonic polypsons deemed not amenable for safe endoscopic resection or where access was difficult, and therefore planned for laparoscopic assistance, were analysed. Clinical data regarding primary lesion, reason for referral for laparoscopic assistance, and outcomes were recorded. Results 15 patients have so far been planned for laparo-endoscopic procedures following multidisciplinary meetings, of whom 1 patient proceeded with surgery alone. 14 patients, with median age 73.0 years (range 35.7–85.1 years) were studied. The main reasons for laparoscopic assistance were: large high risk polyps, unfavourable location and the presence of diverticular disease. The median size of the polyps was 5 cm (range 2.3–15 cm). All procedures were performed under general anaesthetic. Completion of colonoscopic resection was performed with surgical presence without laparoscopic assistance in one. Laparoscopic adhesiolysis was performed in 5 patients to facilitate access. Seven patients required surgical resection (laparoscopic right hemicolectomy in 6 and sigmoid resection in 1). A cancer was confirmed histologically in 3 of these patients, with the other four being adenomas with high-grade dysplasia (HGD, 1) or low grade dysplasia (LGD, 3). In the remaining 7 patients, complete polypectomy was achieved, with histopathology showing adenomas with HGD (2), LGD (1), and lipomas in 3 patients with submucosal lesions, and non-diagnostic material in one patient. Median post-operative length of stay was 2 days (range 1 to 5 days) following colonoscopic resection, and uncomplicated except for post-polypectomy syndrome in one patient. Three of these patients have been followed-up to 6 months, with no recurrence of the lesion seen. Amongst patients requiring surgical resection, length of stay was longer (median 6 days [range 3–21 days], p = 0.002, Mann Whitney), with one patient suffering from anastomotic leak and another from an intra-abdominal fluid collection managed conservatively. Conclusion Attempted laparoscopic-assisted colonoscopic polypectomy is an effective strategy in a selected patients, enabling safe and complete polypectomy for lesions that are difficult to resect at primary colonoscopy. This approach may help to reduce surgical morbidity and reduce length of hospital stay. Disclosure of interest None Declared.