Establishment of Standards for the Referral of Large Non-Pedunculated Colorectal Polyps: An International Expert Consensus Using a Modified Delphi Process.

Colonic Polyps Colorectal Cancer Delphi technique Referral

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
06 Feb 2024
Historique:
received: 26 09 2023
revised: 10 01 2024
accepted: 02 02 2024
medline: 9 2 2024
pubmed: 9 2 2024
entrez: 8 2 2024
Statut: aheadofprint

Résumé

Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large non-pedunculated colorectal polyps are often referred to expert centres for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of our study was to establish minimum expected standards for the referral of LNPCP for potential ER. A Delphi methodology was employed to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and three rounds of surveys were conducted to achieve consensus, with quantitative and qualitative data analysed for each round. A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographics, relevant medications, lesion factors, photodocumentation and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements ranged from 7.04 to 9.29 out of 10, with high percentages of experts considering most statements as a very high priority. Subgroup analysis by continent revealed some variations in consensus rates among experts from different regions. The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large non-pedunculated colorectal polyps are often referred to expert centres for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of our study was to establish minimum expected standards for the referral of LNPCP for potential ER.
METHODS METHODS
A Delphi methodology was employed to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and three rounds of surveys were conducted to achieve consensus, with quantitative and qualitative data analysed for each round.
RESULTS RESULTS
A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographics, relevant medications, lesion factors, photodocumentation and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements ranged from 7.04 to 9.29 out of 10, with high percentages of experts considering most statements as a very high priority. Subgroup analysis by continent revealed some variations in consensus rates among experts from different regions.
CONCLUSION CONCLUSIONS
The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.

Identifiants

pubmed: 38331224
pii: S0016-5107(24)00090-7
doi: 10.1016/j.gie.2024.02.001
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Kareem Khalaf (K)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Samir Seleq (S)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Michael J Bourke (MJ)

Westmead Hospital University of Sydney, Sydney, New South Wales, Australia.

Asma Alkandari (A)

Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait.

Amol Bapaye (A)

Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.

Robert Bechara (R)

Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Natalia C Calo (NC)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Evgeniy D Fedorov (ED)

Pirogov Russia National Research Medical University, Moscow, Russian Federation.

Cesare Hassan (C)

Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.

Mirjana Kalauz (M)

Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia.

Gabor P Kandel (GP)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Takahisa Matsuda (T)

Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.

Gary R May (GR)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Klaus Mönkemüller (K)

Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.

Jeffrey D Mosko (JD)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Akiko Ohno (A)

Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.

Tajana Pavic (T)

Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.

Maria Pellisé (M)

Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain.

Zoe Raos (Z)

Department of Gastroenterology, Te Whatu Ora - Waitemata. Faculty of Medicine, The University of Auckland, Auckland, New Zealand.

Alessandro Repici (A)

Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.

Douglas K Rex (DK)

Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana, USA.

Payal Saxena (P)

AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.

Cameron Schauer (C)

Department of Gastroenterology, Te Whatu Ora - Waitemata. Faculty of Medicine, The University of Auckland, Auckland, New Zealand.

Amrita Sethi (A)

Division of Digestive and Liver Disease, Irving Medical Center, Columbia University, New York, New York, USA.

Prateek Sharma (P)

University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas, USA.

Aasma Shaukat (A)

Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York City, New York, USA.

Uzma D Siddiqui (UD)

Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.

Rajvinder Singh (R)

Lyell McEwin Hospital, NALHN & the University of Adelaide, Adelaide, Australia.

Lesley-Ann Smith (LA)

Department of Gastroenterology, Te Whatu Ora - Te TokaTumai, Auckland, New Zealand.

Mayo Tanabe (M)

Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan.

Christopher W Teshima (CW)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Daniel von Renteln (D)

Centre Hospitalier de l'Universite de Montreal (CHUM), Universite de Montreal, Montreal, Canada.

Nikko Gimpaya (N)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Katarzyna M Pawlak (KM)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Mary Raina Angeli Fujiyoshi (MRA)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Yusuke Fujiyoshi (Y)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Mehul Lamba (M)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Suqing Li (S)

Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Sharan B Malipatil (SB)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.

Samir C Grover (SC)

Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada. Electronic address: samir.grover@utoronto.ca.

Classifications MeSH