Results after endoscopic removal of colorectal lesions using an advanced energy device

1. Rate of complete resection: measuring the number of polyps (percentage) that were completely removed en-bloc (in one piece) to the total number of polyps removed. The rate is compared to the standard benchmark rate of >90%.
1.1. Clinical complete resection is identified during the procedure by the complete removal of the lesion as recorded by the operating physician. Data source: Electronic patients' medical records such as Endoscopy reporting software within the Trust - UniSoft from 01/01/2018 till 30/06/2022 and Solus from 01/07/2022 and onwards. Data recorded on the reporting software at the time of the procedure. Data collection between 01/01/2018 to 01/01/2024.
1.2. Histological complete resection is identified during histological examination of the excised lesion by a consultant histopathologic. Data source: Electronic patients' medical records such as Histology reporting software within the Trust - APEX/DART system and Sunrise. Data recorded at the time of histological assessment on APEX. Typically 2-3 weeks after the procedure. Data collection between 01/01/2018 to 01/01/2024.
2. Rate of conversion to piecemeal resection: measuring the number of polyps (percentage) that were NOT completely removed en-bloc (in one piece) to the total number of polyps removed. The rate is compared to the standard benchmark rate of <10%. Conversion to piecemeal is identified during endoscopic excision of the lesion as recorded by the operating physician on the endoscopy report on the day of the procedure. Data source: Endoscopy reporting software, Unisoft from 010/01/2018 and Solus from 01/07/2022 and onwards unitil 01/01/2024.
3. Rate of immediate complications: measuring the number of patients (percentage) who developed one or more of: intra-procedural bleeding (i.e. within 24 hours of the procedure), perforation (tear of the bowel wall), unplanned admission or any other adverse events/unplanned intervention (like surgery) to the total number of patients.
3.1. Intra-procedural and early bleeding is noted EITHER during the procedure by the operating physician OR reported by patients/health care professionals in the first 24 hours after the procedure. Data source: Unisfot/Solus - data recorded on the reporting system at the time of procedure OR Patient electronic medical records (Sunrise system at EKHUFT) within 24 hours of the procedure. From 01/01/2018 till 01/01/2024.
3.2. Perforation is identified during the endoscopic excision of the lesion by the operating physician. Data source: Endoscopy reporting software within the Trust - UniSoft from 01/01/2018 till 30/06/2022 and Solus from 01/07/2022 and onwards till 01/01/2024. Data recorded on the reporting software at the time of the procedure.
3.3. Unplanned admission: If an unplanned admission took place within 24 hours of the procedure, an inpatient episode is recorded on PAS.
3.4. Unplanned intervention: If an unplanned intervention took place within 24 hours of the procedure, this will be documented on the electronic medical records (Sunrise) as well as on the theatre electronic records (Theatreman). From 01/01/2018 till 01/01/2024.
4. Rate of delayed complications: measuring the number of patients (percentage) who developed one or more of: delayed complications (i.e. after 24 hours of the procedure) delayed bleeding, delayed perforation (tear of the bowel wall), unplanned admission or any other unplanned intervention (like surgery) to the total number of patients.
4.1. Delayed bleeding: measured by the presence of bleeding as reported by patients or health care professionals involved in patient's care - recorded on electronic medical records (Sunrise) AFTER 24 hours of the procedure. From 01/01/2018 till 01/01/2024
4.2. Delayed perforation: measured by the presence of perforation AFTER 24 hours of procedure confirmed by clinical examination by an experienced physician (documented in electronic medical records (data source: Sunrise)) and by imaging modality (e.g. CT scan) as reported by an experienced radiologist (data source - PACS imaging system). From 01/01/2018 till 01/01/2024
4.3. Unplanned admission: If an unplanned admission took place after 24 hours of the procedure, an inpatient episode is recorded on PAS (data source PAS)
4.4. Unplanned intervention: If an unplanned intervention took place after 24 hours of the procedure, this will be documented on the electronic medical records (data source: Sunrise) as well as on the theatre electronic records (data source: Theatreman). From 01/01/2018 till 01/01/2024
5. Surveillance frequency: measuring the number of endoscopies at 6 months, 1 year and 3 years as per the British Society of Gastroenterology guidelines to check for recurrence. Measured using the number of endoscopy checks as documented on endoscopy reporting systems (data source: Unisoft and Solus) at 6 months, 1 year and 3 years after the procedure.
From 01/01/2018 till 01/01/2024.
6. Long-term outcome: measuring the local polyp tissue recurrence rate (number of patients with recurrence of polyp to the total number) and survival rate at 3 years.
6.1. Local recurrence: measured by the presence of polyp tissue recurrence during endoscopy check as reported by the endoscopist on the reporting system. Data source: Unisoft/Solus at 6 months, 1 year and 3 years after the procedure. From 01/01/2018 till 01/01/2024
6.2. Survival/mortality rate: patients who died within 3 years of the procedure will be identified using electronic medical records (Sunrise - date of death is documented on the system at the time of death). From 01/01/2018 till 01/01/2024.

1. Polyp size/surface/location/morphology as documented on the endoscopy report on the day of the procedure from Unisoft/Solus. From 01/01/2018 till 01/10/2024
1.1. Polyp size: each polyp is measured twice by the operating physician after the resection is completed and by the histopathologist before histological assessment. Two measurements of two axes are taken using a ruler after the lesion is pinned to a cork sheet - the longest axis (axis 1) and the one perpendicular to it (axis 2). Source: Endoscopy reporting system (Unisoft/Solus) recorded at time of procedure AND histology reporting system (Apex - typically within 2-3 weeks of procedure).
1.2. Polyp surface: assuming that most polyps are nearly oval in shape, the formula of oval surface is used to calculate the surface - (Axis 1 * Axis 2)/2 * 3.14
1.3. Polyp location and morphology: identified by the operating physician and recorded on Unisoft/Solus at the time of the procedure.
1.4. Time of procedure: recorded by the operating physician and recorded on Unisoft/Solus at end of the procedure. From 01/01/2018 till 01/01/2024
2. Cost analysis from the hospital and NHS perspective conducted using data from the Finance Department of EKHUFT. Cost analysis will combine data from multiple systems within the Trust to provide cost calculations for each case. Sources are: Patient level data – PAS; Theatre data – Theatreman; Imaging – RIS; Pathology – APEX; Drugs – JAC; Endoscopy – Unisoft/ SOLUS (new system from July 2022). From 01/01/2018 till 01/01/2024