Fnu Varnika, MBBS1, Shashank Garg, MD, MS2 1Arkansas Gastroenterology, San Jose, CA; 2Arkansas Gastroenterology, Little Rock, AR
Introduction: Endoscopic mucosal resection (EMR) is recommended method for removing large colon polyps ( > 1 cm) to ensure complete removal of the polyp while minimizing the risk of complications. This is a high-risk procedure and is therefore performed in hospital-based endoscopy units. We looked at feasibility and safety of EMR of large colon polyps performed at an ambulatory surgery center (ASC).
Methods: This was a quality improvement project performed from colonoscopy quality data collected for participation in GIQuIC registry. All patients undergoing EMR at our ASC from July 1 st
2021 to April 11 th
, 2023 were included in the study. Technique and equipment used for EMR was determined by the gastroenterologist performing the procedure based on location, size and morphology of the polyp. Demographics, BMI, ASA class, procedure details (indication, type of sedation, withdrawal time), colonoscopy findings (details of polyp being removed with EMR) and pathology reports were obtained. Descriptive statistical methods were used to analyze the data. Data analysis was performed using SAS (version 9.4, SAS Institute Inc., NC, USA).
Results: A total of 223 patients underwent EMR of 294 colon polyps at ASC during the study period. Median age of the patients was 66 years (Interquartile range, IQR 58-72 years). 142 (48.3%) patients were male. Median BMI was 29.31 (IQR 25.25-33.01). Certain procedure related details are provided in table 1. Median withdrawal time was 25 minutes (IQR 19-32 min). Median size of the polyps was 18 mm (IQR 15-20 mm). 110 (37.41%) polyps were removed with cold EMR and 184 (62.59%) polyps were removed with cautery. 225 (76.53%) polyps were removed en-bloc and 69 (23.47%) were removed piecemeal. 13 (4.42%) patients had immediate post polypectomy bleeding requiring hemostasis, one (0.34%) patient had delayed post-polypectomy bleeding and one (0.34%) patient had immediate perforation requiring surgery.
Discussion: EMR for large colon polyps can be performed safely and effectively at ASCs by gastroenterologists who have had training in EMR of large colon polyps. This endeavor should be undertaken in agreement with various stakeholders including ASC administration, other physicians and endoscopy staff working at the surgery center.
Disclosures:
Fnu Varnika indicated no relevant financial relationships.
Shashank Garg indicated no relevant financial relationships.
Fnu Varnika, MBBS1, Shashank Garg, MD, MS2. P2280 - Feasibility and Safety of Endoscopic Mucosal Resection of Large Colon Polyps Performed at an Ambulatory Surgery Center: A Retrospective Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
