Improving the Management of Large Colorectal Polyps

This thesis is focused on identifying current practices in the management of large non pedunculated colorectal polyps (LNPCPs) and the development of a structured management framework to improve outcomes. The methodology used includes a systematic review to ascertain current knowledge and retrospective quantitative analysis to identify current LNPCP management outcomes. The English Bowel Cancer Screening Programme (BCSP) which has a high volume of recorded LNPCP data was used to facilitate the latter process. In addition, qualitative analysis using consensus methodology to create best practice guidelines, key performance indicators (KPIs) to audit LNPCP outcomes and a complex polyp multidisciplinary team process was undertaken. The main outcomes of this thesis were: 1. Confirmation of variation in LNPCP management practices leading to variable outcomes 2. Formulation of evidence based and expert consensus LNPCP management guidelines 3. Identification of KPIs to allow audit of LNPCP management and outcomes 4. Identification of pertinent research questions to improve evidence LNPCP base 5. Development and pilot of regional complex polyp multidisciplinary team meeting