Currently, there is no national endoscopic database in England. Information regarding
the volume of therapeutic endoscopic procedures such as polypectomy is obtained
mainly from small prospective studies. We examined the Hospital Episode Statistics
(HES) national database to assess the number of patients who underwent a therapeutic
polypectomy for a primary diagnosis of a benign colorectal polyp over a 10 year
period, as well as analysing outcomes from the first three years of bowel cancer
screening at a single tertiary endoscopy centre.
Despite the ubiquitous use of endoscopic snare polypectomy over the last four
decades, there has been a void in formal training and assessment of polypectomy
skills in the UK. We aimed to develop and validate an objective, structured
assessment tool for assessing polypectomy competency in skilled accredited Bowel
Cancer Screening endoscopists. This study led to the development of the DOPyS
(Direct Observation of Polypectomy Skills) assessment tool. Validation and reliability
of the DOPyS was demonstrated through assessment of polypectomy videos,
performed by accredited Bowel Cancer Screening endoscopists, using Generalisability
Theory (G theory). Construct validity of the DOPyS, and its ability to assess
piecemeal Endoscopic Mucosal Resection, were determined through separate studies.
The DOPyS validation studies highlighted variability in assessor scoring and DOPyS
training days were held for Bowel Cancer Screening assessors in England, in order to
align opinions prior to the implementation of the DOPyS into the Bowel Cancer
Screening Accreditation Process in England.
Finally, in an effort to provide a structure for improved polypectomy outcomes and
referral systems, a study was performed to determine the difficulty ‘level’ of a
polypectomy, based on polyp characteristics.