Objective: To analyze presentation, management and outcomes of large (≥ 20 mm) polyps (LPs) detected in a colorectal cancer (CRC) screening program using a fecal immunochemical test (FIT). Design: Retrospective population-based study of all LPs detected in patients aged 50-74 years between 2015 and 2019 during FIT-positive colonoscopies within the screening program organized in Alsace (France). Results: Among 13,633 FIT-positive colonoscopies, 1256 LPs (8.5% malignant and 51.8% non-pedunculated) were detected by 102 community gastroenterologists in 1164 patients (one in 12 colonoscopies). The sensitivity of optical diagnosis of malignancy was 54% for non-pedunculated and 27% for pedunculated T1 CRCs. Endoscopic resection rate was 82.7% [95% CI 80.3-84.9] for benign LPs (70.2% [95% CI 66.4-74.1] non-pedunculated, 95.2% [95% CI 93.4-97.1] pedunculated, p<0.001), varying from 0 to 100% depending on the endoscopist. It was correlated with cecal intubation (Pearson r = 0.49, p<0.01) and adenoma detection (r = 0.25, p=0.01) rates. Most endoscopists did not refer patients to more experienced endoscopists, so that 60 to 90% of 183 surgeries for benign LPs were unwarranted. Endoscopic resection was curative for 4.3% [95% CI 0.9-12.0] of non-pedunculated and 37.8% [95% CI 22.5-55.2] of pedunculated T1 CRCs. Overall, 22 endoscopic submucosal dissections had to be performed to avoid one surgery. Conclusion: Compared with current recommendations, there is tremendous room for improvement of community endoscopy practices for the diagnosis and management of LPs. Detection and polypectomy competencies are correlated and highly variable among endoscopists. Endoscopic resection is curative in 83% of benign LPs and 16% of T1 CRCs.

中文翻译：

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粪便免疫化学测试在大肠癌筛查程序中管理大息肉：一项基于人群的研究

目的：使用粪便免疫化学测试（FIT）分析在结直肠癌（CRC）筛查程序中检测到的大（≥20 mm）息肉（LP）的表现，治疗和结局。设计：在法国阿尔萨斯市组织的筛查计划中，对FIT阳性结肠镜检查期间2015年至2019年期间在50-74岁的患者中检测到的所有LP进行了基于人群的回顾性研究。结果：在13633名FIT阳性结肠镜检查中，由102位社区胃肠病学家在1164名患者中检出1256例LP（恶性为8.5％，未带蒂的为51.8％）（12例结肠镜检查中有1例）。光学诊断恶性肿瘤的无蒂T1 CRCs为54％，有蒂T1 CRCs为27％。良性LP的内镜切除率为82.7％[95％CI 80.3-84.9]（无蒂的为70.2％[95％CI 66.4-74.1]，95.2％[95％CI 93.4-97]。1]有蒂，p <0.001），根据内镜医师的不同，从0％到100％不等。它与盲肠插管（Pearson r = 0.49，p <0.01）和腺瘤检出率（r = 0.25，p = 0.01）相关。大多数内镜医师没有将患者转介给经验更丰富的内镜医师，因此在183次良性LP手术中，有60％至90％是不必要的。内镜下切除治疗无蒂的有4.3％[95％CI 0.9-12.0]，有蒂的T1 CRC有37.8％[95％CI 22.5-55.2]。总体而言，必须进行22例内镜下黏膜下剥离术，以避免一项手术。结论：与当前的建议相比，社区内窥镜检查法在诊断和管理LPs方面仍有很大的改进空间。内镜医师之间的检测能力和息肉切除术的能力是相关的并且高度可变。