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Lookup NU author(s): Professor Matt Rutter, Professor Raj Ranjan, Adam BiranORCiD, Peter Coyne, Professor Linda Sharp
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© Author(s) (or their employer(s)) 2025.Background: Determining optimal management of colorectal polyps in patients with limited life expectancy of under 10 years can be difficult, due to challenges balancing an uncertain natural history of polyp progression to symptomatic malignancy versus the increased risk and consequences of polypectomy complications. Aim: This British Society of Gastroenterology and Association of Coloproctologists of Great Britain and Ireland guidance aims to help clinicians and patients consider these risks to aid decision-making for polypectomy versus a conservative approach. Methods: A guidance development group comprising 28 members was established, including gastroenterologists, colorectal surgeons, elderly care physicians, anaesthetists, epidemiologists, nurse endoscopists, a general practitioner and patient representatives. Estimates on life expectancy stratified by age and comorbidity, polyp dwell time for differing polyp sizes, cancer sojourn time and polypectomy complication rates for comorbid/elderly patients both on and off antithrombotic medication were collated from various literature searches. A model was created to compare the risk of symptomatic malignancy in a patient's lifetime against the risk of significant complications. Results: Following a modified Delphi consensus process and after three rounds of voting, 33 recommendations were made within 10 domains (principles, diagnostic investigation, life expectancy, polyp and cancer natural history, polypectomy risks, management recommendations, follow-up, decision-making practicalities, training and education, future research). A table was created, summarising whether polypectomy or conservative management might be the favoured option for 40 clinical scenarios of patients with differing life expectancy, polyp sizes and use of antithrombotic medication. Conclusions: This guidance provides a framework to facilitate more objective and informed decision-making, from which an individualised plan can be developed between the patient and their clinician.
Author(s): Rutter MD, Ranjan R, Westwood C, Barbour J, Biran A, Blackett H, Burr NE, Carlisle J, Clare B, Cripps N, Coyne P, Dolwani S, Hodson R, Holtham S, Mohammed N, Morris EJA, Neilson L, Oliphant R, Painter J, Prakash A, Pullan R, Sarkar S, Sloan M, Swart M, Thomas-Gibson S, Trudgill NJ, Vance M, Yeadon K, Sharp L
Publication type: Article
Publication status: Published
Journal: Gut
Year: 2025
Pages: epub ahead of print
Online publication date: 29/04/2025
Acceptance date: 11/04/2025
Date deposited: 20/05/2025
ISSN (print): 0017-5749
ISSN (electronic): 1468-3288
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/gutjnl-2025-335047
DOI: 10.1136/gutjnl-2025-335047
PubMed id: 40301120
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