Establishment of standards for the referral of large nonpedunculated colorectal polyps: an international expert consensus using a modified Delphi process

• Published in: Gastrointestinal endoscopy 2024-09, Vol.100 (3), p.510-516.e6
• Main Authors: Khalaf, Kareem, Seleq, Samir, Bourke, Michael J., Alkandari, Asma, Bapaye, Amol, Bechara, Robert, Calo, Natalia C., Fedorov, Evgeniy D., Hassan, Cesare, Kalauz, Mirjana, Kandel, Gabor P., Matsuda, Takahisa, May, Gary R., Mönkemüller, Klaus, Mosko, Jeffrey D., Ohno, Akiko, Pavic, Tajana, Pellisé, Maria, Raos, Zoe, Repici, Alessandro, Rex, Douglas K., Saxena, Payal, Schauer, Cameron, Sethi, Amrita, Sharma, Prateek, Shaukat, Aasma, Siddiqui, Uzma D., Singh, Rajvinder, Smith, Lesley-Ann, Tanabe, Mayo, Teshima, Christopher W., von Renteln, Daniel, Gimpaya, Nikko, Pawlak, Katarzyna M., Angeli Fujiyoshi, Mary Raina, Fujiyoshi, Yusuke, Lamba, Mehul, Li, Suqing, Malipatil, Sharan B., Grover, Samir C.
• Format: Article
• Language: English
• Subjects: Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy - standards; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Consensus; Delphi Technique; Humans; Referral and Consultation - standards
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2024.02.001

Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large nonpedunculated colorectal polyps are often referred to expert centers 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 this study was to establish minimum expected standards for the referral of large nonpedunculated colonic polyps for potential endoscopic resection. A Delphi method was used 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 3 rounds of surveys were conducted to achieve consensus. Quantitative and qualitative data were analyzed 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 demographic characteristics, 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, which were scored on a scale of 1 to 10, ranged from 7.04 to 9.29, with high percentages of experts considering most statements as a very high priority. Subgroup analysis according to 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.