General Versus Interventional Gastroenterologists: A Comparative Analysis of Follow-Up Outcomes After Endoscopic Mucosal Resection of Colorectal Polyps

Introduction Colorectal cancer (CRC) represents a major global health burden, significantly impacting mortality rates and healthcare systems worldwide. CRC screening through colonoscopy enables early detection and removal of precancerous polyps. While standard polypectomy suffices for small polyps, larger ones require endoscopic mucosal resection (EMR). Though post-EMR surveillance is crucial for preventing recurrence, it remains unclear whether follow-up by general gastroenterologists yields comparable outcomes to surveillance by interventional specialists. This distinction carries significant implications for resource allocation, particularly given the limited availability of interventional gastroenterologists whose expertise is needed for other complex procedures. Our study examines this unexplored question by comparing post-EMR surveillance outcomes between these provider groups. Methods We conducted a retrospective study at the Saint Louis Veterans Affairs (VA) Health Care System of patients presenting for follow-up of colorectal polyp EMR between January 2019 and December 2022. Pre-defined variables extracted from the electronic medical record system were then analyzed to discern significant differences between general and interventional gastroenterologists' outcomes. The primary outcome includes the rate of biopsy of scars after EMR between both groups. Additional outcomes include the number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy and mode of polypectomy, recommended surveillance interval suggested by the endoscopist, and the pathology of the EMR site biopsy. Results A total of 59 (N = 59) patients (median age: 67, mean age: 66.5 ± 6.6 years) met the inclusion criteria of our study. General gastroenterologists were more likely to biopsy the EMR site compared to interventional gastroenterologists (65% vs. 40%, p = 0.047). There was no difference in overall pathology detected when comparing general and interventional gastroenterologists (p = 0.074). While no EMR site biopsies were obtained in 16 patients (27.1%), there were no differences in the pathology of patients undergoing biopsy of the scar. Additionally, no significant differences were found in the Boston Bowel Preparation Score, number of polyps detected, detection of residual tissue at the EMR site, EMR site recurrence requiring polypectomy, or recommended surveillance interval. Conclusion Our study provides evidence that the outcomes of post-EMR follow-up are largely comparable between general and interventional gastroenterologists. Although general gastroenterologists exhibit higher rates of EMR site biopsy, the associated pathology shows no significant difference.