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

Kareem Khalaf¹, Samir Seleq¹, Michael J Bourke², Asma Alkandari³, Amol Bapaye⁴, Robert Bechara⁵, Natalia C Calo¹, Evgeniy D Fedorov⁶, Cesare Hassan⁷, Mirjana Kalauz⁸, Gabor P Kandel¹, Takahisa Matsuda⁹, Gary R May¹, Klaus Mönkemüller¹⁰, Jeffrey D Mosko¹, Akiko Ohno¹¹, Tajana Pavic¹², Maria Pellisé¹³, Zoe Raos¹⁴, Alessandro Repici⁷, Douglas K Rex¹⁵, Payal Saxena¹⁶, Cameron Schauer¹⁴, Amrita Sethi¹⁷, Prateek Sharma¹⁸, Aasma Shaukat¹⁹, Uzma D Siddiqui²⁰, Rajvinder Singh²¹, Lesley-Ann Smith¹⁴, Mayo Tanabe²², Christopher W Teshima¹, Daniel von Renteln²³, Nikko Gimpaya¹, Katarzyna M Pawlak¹, Mary Raina Angeli Fujiyoshi¹, Yusuke Fujiyoshi¹, Mehul Lamba¹, Suqing Li²⁴, Sharan B Malipatil¹, Samir C Grover²⁵

Affiliations

¹ Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.
² Westmead Hospital University of Sydney, Sydney, New South Wales, Australia.
³ Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait City, Kuwait.
⁴ Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
⁵ Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
⁶ Pirogov Russia National Research Medical University, Moscow, Russian Federation.
⁷ Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
⁸ Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia.
⁹ Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
¹⁰ Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
¹¹ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.
¹² Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
¹³ Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
¹⁴ Department of Gastroenterology, Te Whatu Ora-Waitemata, Faculty of Medicine, The University of Auckland, Auckland, New Zealand.
¹⁵ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁶ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁷ Division of Digestive and Liver Disease, Irving Medical Center, Columbia University, New York, New York, USA.
¹⁸ University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas, USA.
¹⁹ Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York City, New York, USA.
²⁰ Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
²¹ Lyell McEwin Hospital, NALHN & the University of Adelaide, Adelaide, South Australia, Australia.
²² Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan.
²³ Centre Hospitalier de l'Universite de Montreal (CHUM), Universite de Montreal, Montreal, Quebec, Canada.
²⁴ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁵ Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada; Scarborough Health Network, Toronto, Ontario, Canada. Electronic address: samir.grover@utoronto.ca.

PMID: 38331224
DOI: 10.1016/j.gie.2024.02.001

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

Kareem Khalaf et al. Gastrointest Endosc. 2024 Sep.

. 2024 Sep;100(3):510-516.e6.

doi: 10.1016/j.gie.2024.02.001. Epub 2024 Feb 7.

Authors

Affiliations

¹ Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.
² Westmead Hospital University of Sydney, Sydney, New South Wales, Australia.
³ Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait City, Kuwait.
⁴ Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
⁵ Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
⁶ Pirogov Russia National Research Medical University, Moscow, Russian Federation.
⁷ Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
⁸ Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia.
⁹ Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
¹⁰ Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
¹¹ Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan.
¹² Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia.
¹³ Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
¹⁴ Department of Gastroenterology, Te Whatu Ora-Waitemata, Faculty of Medicine, The University of Auckland, Auckland, New Zealand.
¹⁵ Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁶ AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
¹⁷ Division of Digestive and Liver Disease, Irving Medical Center, Columbia University, New York, New York, USA.
¹⁸ University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas, USA.
¹⁹ Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York City, New York, USA.
²⁰ Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
²¹ Lyell McEwin Hospital, NALHN & the University of Adelaide, Adelaide, South Australia, Australia.
²² Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan.
²³ Centre Hospitalier de l'Universite de Montreal (CHUM), Universite de Montreal, Montreal, Quebec, Canada.
²⁴ Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁵ Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada; Scarborough Health Network, Toronto, Ontario, Canada. Electronic address: samir.grover@utoronto.ca.

PMID: 38331224
DOI: 10.1016/j.gie.2024.02.001

Abstract

Background and aims: 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.

Methods: 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.

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 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.

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.

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Conflict of interest statement

Disclosure The following authors disclosed financial relationships: A. Sethi: consultant for Boston Scientific, Interscope, Medtronic, and Olympus; research support from Boston Scientific and Fujifilm; advisory board member for Endosound. K. Mönkemüller: consultant for Ovesco USA and Ovesco Germany. T. Pavic: speaker for Olympus and Boston Scientific. M. J. Bourke: research support for ethics-approved studies from Cook Medical, Olympus Medical, and Boston Scientific. P. Saxena: consultant for Boston Scientific, Ambu, and Erbe. D. K. Rex: Consultant for Olympus Corporation, Boston Scientific, Braintree Laboratories, Norgine, Medtronic, and Acacia Pharmaceuticals; research support from Olympus Corporation, Medivators, Erbe USA Inc, and Braintree Laboratories; shareholder with Satisfai Health. U. D. Siddiqui: research, consultant, and speaker for Olympus and Boston Scientific; and consultant and speaker for CONMED, Cook, and Medtronic. M. Pellisé: clinical advisory boards for Fujifilm Europe and Olympus; clinical advisory board and share options in MiWEndo; speaker fees from Casen Recordati, Norgine Iberia, Fujifilm, Mayoli, Medtronic, and Olympus; and research funding from Fujifilm, Casen Recordati, Ziuz, and 3-D Matrix. J. D. Mosko: Consulting: Boston Scientific, Fuji, Medtronic, Pendopharm, and Steris; research funding from Boston Scientific and Vantage/ERBE. C. W. Teshima: speaker for Medtronic and Boston Scientific; and consultant for Boston Scientific. G. R. May: consultant for Olympus; and speaker for Pentax, Fuji, and Medtronic. S. C. Grover: research grants and personal fees from AbbVie and Ferring Pharmaceuticals; personal fees from Takeda, Sanofi, and BioJAMP; education grants from Janssen; and equity shares in Volo Healthcare. C. Hassan: consultant for Fujifilm and Medtronic; and research grants from Fujifilm and NEC. A. Repici: consultant for Fujifilm, Olympus Corp, and Medtronic; and research grants from Fujifilm and NEC. P. Sharma: consultant for Olympus Corporation, Boston Scientific, Salix Pharmaceuticals, Cipla, Medtronic, Takeda, Samsung Bioepis, and CDx; and grant support from ERBE and Fujifilm. R. Bechara: consultant for Olympus, Pentax, Vantage, Medtronic, and Pendopharm. A. Shaukat: Consultant for Itertive Health, Freenome, UniversalDx, and Motus GI. All other authors disclosed no relevant financial disclosures or conflicts of interest to declare. The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources

Medical