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High burden of polyp mischaracterisation in tertiary centre referrals for endoscopic resection may be alleviated by telestration
  1. Sri Thrumurthy1,
  2. Hein Myat Thu Htet2,
  3. Deepa Denesh3,
  4. Kesavan Kandiah4,
  5. Noor Mohammed5,6,
  6. Shraddha Gulati1,
  7. Andrew Emmanuel1,
  8. Pradeep Bhandari7,
  9. Amyn Haji8,
  10. Bu'Hussain Hayee8
  1. 1Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
  2. 2Gastroenterology, Barts Health NHS Trust, London, UK
  3. 3Endoscopy, St James's University Hospital, Leeds, West Yorkshire, UK
  4. 4Endoscopy, St George's University Hospitals NHS Foundation Trust, London, UK
  5. 5Gastroenterology, St James's University Hospital, Leeds, UK
  6. 6Endoscopy, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
  7. 7Gastoenterology, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
  8. 8Endoscopy, King's College Hospital, London, UK
  1. Correspondence to Bu'Hussain Hayee, King's College Hospital, London SE5 9RS, UK; b.hayee{at}


Objective Endoscopic resection (ER) often involves referral to tertiary centres with high volume practices. Lesions can be subject to prior manipulation and mischaracterisation of features required for accurate planning, leading to prolonged or cancelled procedures. As potential solutions, repeating diagnostic procedures is burdensome for services and patients, while even enriched written reports and still images provide insufficient information to plan ER. This project sought to determine the frequency and implications of polyp mischaracterisation and whether the use of telestration might prevent it.

Design/method A retrospective data analysis of ER referrals to four tertiary centres was conducted for the period July–December 2019. Prospective telestration with a novel digital platform was then performed between centres to achieve consensus on polyp features and ER planning.

Results 163 lesions (163 patients; mean age 67.9±12.2 y; F=62) referred from regional hospitals, were included. Lesion site was mismatched in 11 (6.7%). Size was not mentioned in the referral in 27/163 (16.6%) and incorrect in 81/136 (51.5%), more commonly underestimated by the referring centre (<0.0001), by a mean factor of 1.85±0.79. Incurred procedure time (in units of 20 min) was significantly greater than that allocated (p=0.0085). For 10 cases discussed prospectively, rapid consensus on lesion features was achieved, with agreement between experts on time required for ER.

Conclusions Polyp mischaracterisation is a frequent feature of ER referrals, but could be corrected by the use of telestration between centres. Our study involved expert-to-expert consensus, so extending to ‘real-world’ referring centres would offer additional learning for a digital pathway.


Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study.

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  • Contributors BH planned the study. BH, PB, NM and KK conducted telestration and all authors either performed or assisted in complex polypectomy procedures. ST and BH drafted the initial manuscript and analysed results, while all authors refined and edited the final version. BH is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BH and PB are minority shareholders in Surgease Innovations Ltd.

  • Provenance and peer review Not commissioned; externally peer reviewed.