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TRENDS IN SURGICAL AND ENDOSCOPIC RESECTION INTERVENTION FOR NON-MALIGNANT COLORECTAL POLYPS OVER THE LAST DECADE: A NATIONWIDE ANALYSIS
Yassine Kilani
*1, Mahmoud Y. Madi
1, Ahmad Najdat Bazarbashi
4, Thomas R. McCarty
3, Raj Shah
21Gastroenterology & Hepatology, Saint Louis University, Saint Louis, MO; 2The Ohio State University Wexner Medical Center, Columbus, OH; 3Houston Methodist, Houston, TX; 4Washington University in St Louis, St. Louis, MO
Background
Surgery for non-malignant colorectal polyps is rarely performed and is considered if endoscopic removal is not feasible or unsuccessful. Recent data on the trends of surgery for non-malignant colorectal polyps in the U.S. are lacking, especially with the development of enhanced endoscopic mucosal resection (EMR) techniques and the advancements in endoscopic submucosal dissection (ESD). We aimed to evaluate the trend of surgery and endoscopic resection in patients with non-malignant colorectal polyps from 2014 to 2024.
Methods
We conducted a retrospective cohort study in the United States using the TriNetX research network to identify patients with non-malignant colorectal polyps who underwent surgery. After excluding patients with colorectal cancer and other surgical indications (peritonitis, perforation, inflammatory bowel diseases, strictures, fistulas, abscesses, toxic megacolon, diverticulitis with perforation/abscess, small or large bowel obstruction), we assessed the yearly incidence of colorectal surgery from 2014 to 2024 using CPT codes for partial or total enterectomy, colectomy, &/or proctectomy (44160, 44210, 44147, 1007480, 1007455, 1007463 1007468, 1007473 1007599). Furthermore, we assessed EMR (CPT: 45390, 45349) and ESD (HCPCS: C9779) rates in this population from 2014 to 2024. We retrieved data on baseline characteristics, including demographics (e.g., age, sex, race), body mass index (BMI), smoking history, alcohol use, family history of colorectal polyps or gastrointestinal malignancy.
Results
A total of 2,007,176 adult patients had non-malignant colorectal polyps from 2014 to 2024, among which 0.46% (n=9268) underwent colorectal surgery. Patients who underwent surgery for the treatment of colorectal polyps were younger (61 ± 13 years vs. 63 ± 11 years, p=0.032) and were more likely to be White (75% vs. 70%, p<0.001) and have a family history of colorectal cancer (2.5% vs. 1.5%. p<0.001) compared to patients undergoing EMR or ESD (Table 1). [RS1] There was no significant difference in the trends of colorectal surgery in patients with colorectal polyps from 2014 to 2024 (Incidence proportion: 2014 - 0.04%, 2024 – 0.05%; Figure 1-A). In contrast, there was a notable increase in EMR and ESD rates in patients with colorectal polyps from 2014 to 2024 (Incidence proportion: 2014 - 0.001%, 2024 – 0.51%; Figure 1-B)
Conclusion
There is an overall low rate of colon surgery for non malignant polyps. There has been no significant change in trend over the past 10 years, despite advances in EMR and ESD for this patient population. Future studies are needed to understand the reason for these trends and interventions to enhance the uptake of organ sparing polyp resection.
TRENDS IN SURGICAL AND ENDOSCOPIC RESECTION INTERVENTION FOR NON-MALIGNANT COLORECTAL POLYPS OVER THE LAST DECADE: A NATIONWIDE ANALYSIS
Figure 1. Incidence of colorectal surgery (
A) and endoscopic resection therapy (e.g., endoscopic mucosal resection, endoscopic submucosal dissection) (
B) in patients with colorectal polyps and without colorectal cancer from 2014 to 2024
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