title: Management of complex colonic polyps in the English Bowel Cancer Screening Programme.
abstract: BACKGROUND
  Large sessile or flat colonic polyps, defined as polyps at least 20  mm in size, are difficult to treat endoscopically and may harbour malignancy. The aim of this study was to describe their current management to provide insight into optimal management.
  
  
  METHODS
  This retrospective observational study identified patients with large sessile or flat polyps detected in the English Bowel Cancer Screening Programme between 2006 and 2009. Initial therapeutic modality (surgical or endoscopic), subsequent management and outcomes were recorded. The main outcome measures analysed were: presence of malignancy, need for surgical treatment, complications, and residual or recurrent polyp at 12 months.
  
  
  RESULTS
  In total, 557 large sessile or flat polyps with benign appearance or initial histology were identified in 557 patients. Some 436 (78.3 per cent) were initially managed endoscopically and 121 (21.7 per cent) were managed surgically from the outset. Seventy of those initially treated endoscopically subsequently required surgery owing to the presence of malignancy (19) or not being suitable for further endoscopic management (51). Residual or recurrent polyp was present at 12 months in 26 (6.0 per cent) of 436 patients managed endoscopically. There was wide variation between centres in the use of surgery as a primary therapy, ranging from 7 to 36 per cent. Endoscopic complications included bleeding in 13 patients (3.0 per cent) and perforation in two (0.5 per cent).
  
  
  CONCLUSIONS
  Management of large sessile or flat colonic polyps is safe and effective in the English Bowel Cancer Screening Programme. Wide variation in the use of surgery suggests a need for standardized management algorithms. Presented to a meeting of the British Society of Gastroenterology, Birmingham, U.K., March 2011.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne; University Hospital of North Tees, Stockton-on-Tees.
authors.forename: T J W
authors.initials: TJ
authors.lastname: Lee
authors.forename: C J
authors.initials: CJ
authors.lastname: Rees
authors.forename: C
authors.initials: C
authors.lastname: Nickerson
authors.forename: J
authors.initials: J
authors.lastname: Stebbing
authors.forename: J F
authors.initials: JF
authors.lastname: Abercrombie
authors.forename: R J Q
authors.initials: RJ
authors.lastname: McNally
authors.forename: M D
authors.initials: MD
authors.lastname: Rutter
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000517:prevention & control; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome