S567 Polypectomy Guideline Adherence Across 369 Colonoscopies at an Academic Center: A Quality Improvement Project

Introduction: Colonoscopy and polypectomy remain cornerstone strategies for the early detection and prevention of colorectal cancer. A 2024 American Gastroenterological Association practice update recommends cold forceps polypectomy (CFP) for diminutive polyps <4 mm, cold snare polypectomy (CSP) for polyps of any size, and hot snare polypectomy (HSP) for lesions >10 mm. We aimed to increase adherence to guideline-directed polypectomy techniques at our institution via 2 targeted educational interventions: a journal club discussion on October 7, 2024 and a grand rounds lecture on October 9, 2024. Here we present polypectomy metrics during the 5 months preceding and following the interventions. Methods: We conducted a retrospective analysis and identified adults who underwent colonoscopy between May 10, 2024, and March 9, 2025. Procedure reports were reviewed and patient age, sex, polyp size, and polypectomy technique were recorded. After excluding polypectomies where size or polypectomy technique were omitted, statistical comparison between the pre- and post-intervention cohort was performed. Results: Of the 2,434 adult colonoscopies performed during the ten-month study period, 377 procedures were documented as “colonoscopy with excision lesion” and included for detailed review. After excluding procedures with incomplete data, 369 colonoscopies remained. Among the 185 pre-intervention colonoscopies, a total of 371 polypectomies were performed: CFP was used in 89 cases, CSP in 260, and HSP in 22. Among the 184 post-intervention colonoscopies, 321 polypectomies were performed: CFP was used in 89 cases, CSP in 210, and HSP in 22. Guideline-discordant polypectomies occurred in 7 cases (1.89%) prior to the intervention, and 4 cases (1.25%) following the intervention. Although there was a reduction in discordant polypectomies from 1.89% to 1.25%, the difference was not statistically significant (P = 0.51). Conclusion: There was no significant difference in polypectomy practice before and after the intervention, suggesting that isolated educational sessions alone are insufficient to drive sustained change in polypectomy practices. In contrast, quality improvement efforts such as adenoma detection rate monitoring have demonstrated that regular, provider-specific feedback is more effective in modifying behavior. Our findings highlight the need for continuous, data-informed reinforcement rather than one-time interventions to meaningfully improve polypectomy quality.