Document resource
Introduction The BSG/ACPGBI published guidelines in 2025 which provide a patient-centred framework for managing colorectal polyps in individuals with limited life expectancy (LLE). This study aimed to retrospectively evaluate how historical practice at a large NHS Trust aligns with the LLE guidelines and to determine how many procedures might, in hindsight, have been approached more conservatively.Methods 950 large non-pedunculated colorectal polyps (LNPCP) managed between 2016 and 2025 were prospectively recorded in a digital database. A retrospective analysis was performed. The Charlson Comorbidity Index and anticoagulant/antiplatelet use at the time of procedure were extracted from clinic correspondence and endoscopy unit documentation. Each patient’s estimated life expectancy was categorised according to the BSG/ACPGBI 2025 guidelines LLE framework, and cases were reviewed on a per-patient basis to evaluate the appropriateness of polypectomy. Patients were stratified as Green (favours polypectomy), Amber (marginal), or Red (favours conservative management).Results This study included 950 LNPCPs in 835 patients, with a mean age of 67.2 years. The mean lesion size was 29.8 mm. 601 polyps were SMSA level 3 and 349 were level 4. On histological examination, 329 lesions were sessile serrated lesions, 586 were adenomas, and 35 were diagnosed as cancer.At the first and second site check procedures, recurrence rates were 14% and 3.8% respectively. The majority of recurrent polyps (99%) were treated endoscopically, with one case requiring surgical management.Complications included 9 cases of post-polypectomy syndrome, 23 delayed bleeds, 1 perforation, 1 micro perforation with associated bleeding and 2 ischaemic events. There were 29 unplanned admissions, 4 cases requiring both unplanned admission and transfusion, 2 cases requiring surgery and 1 case of permanent disability. 83 patients died within nine years of the index procedure.When reclassified according to the LLE guidelines, 783 patients (93.77%) were categorised as Green, 34 (4.07%) as Amber, and 18 (2.15%) as Red. Furthermore, out of 36 recorded complications, 30 (83%) occurred in the green cohort and 6 (17%) in amber and red cohort. This corresponds to approximately a three-fold higher relative risk of complications in amber and red cohort (95% CI 1.31-6.90; p 0.02).Overall, 6% of cases (Amber and Red) would, under new guidance, be considered for conservative management.Conclusions Applying the BSG/ACPGBI LLE guidelines to nearly a decade of practice showed that most historical polypectomy decisions were consistent with the new recommendations. However, a small but important subset of procedures might have warranted a more cautious, conservative approach.Adopting the LLE guidelines and using them in decision making regarding all LNPCPs, including SPEC (Significant Polyp and Early Cancer) should help further reduce performing polypectomy in patients who derive minimal or no benefit.