Trends in Surgical and Endoscopic Resection Intervention for Non-malignant Colorectal Polyps Over the Last Decade: A Nationwide Analysis

Introduction: Surgery for non-malignant colorectal polyps is rarely performed and is considered if endoscopic removal is not feasible or unsuccessful, especially since the development of enhanced endoscopic mucosal resection (EMR) techniques and the advancements in endoscopic submucosal dissection (ESD). We aimed to evaluate the trend of surgery and endoscopic resection in patients with non-malignant colorectal polyps from 2014 to 2024. Methods: We conducted a retrospective cohort study in the United States using the TriNetX research network to identify patients with non-malignant colorectal polyps who underwent surgery. After excluding patients with colorectal cancer and other surgical indications, we assessed the yearly incidence of colorectal surgery from 2014 to 2024 using CPT and ICD10 codes for partial colectomy &/or proctectomy. Furthermore, we assessed EMR and ESD rates in this population from 2014 to 2024. Results: A total of 1,693,869 adult patients had non-malignant colorectal polyps from 2014 to 2024, among which 5750 (0.3%) underwent surgery and, while 112,029 (6.6%) underwent endoscopic resection techniques (ERT) with either EMR or ESD. From 2014 to 2024, the incidence of colorectal surgery for patients with colorectal polyps declined from 4.1 to 3.0 per 1000 cases, whereas the utilization of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) demonstrated a significant upward trend, increasing from 52.8 to 64.3 per 1000 cases over the same period. Conclusions: Over the past 10 years, there has been a modest decline in surgery rates for nonmalignant colorectal polyps, coinciding with increasing rates of EMRs and ESDs. Future studies are needed to understand reason for these trends and interventions to enhance the uptake of organ sparing polyp resection.