Abstracts 2002 Endoscopic Versus Surgical Resection for Benign Complex Colon Polyps: Practice Patterns at an Academic Medical Center and Factors Influencing Management Anna Lipowska, MD, Srinadh Komanduri, MD, Rajesh Keswani, MD. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Introduction: Patients with complex colon polyps (CCP) may be referred for either endoscopic mucosal resection (EMR) or surgical resection (SR). EMR has previously been shown to be more cost-effective with a high success rate. The primary aim of this study is to determine utilization of EMR and SR for CCP and factors influencing the use of EMR versus SR at an academic medical center. Methods: We conducted a retrospective cohort study of patients with a CCP over a two year period (2012 to 2013) referred to either SR or to one of two specialists in EMR. A CCP was defined as a polyp not amenable to removal by the referring endoscopist with a hyperplastic, serrated, or adenomatous (including intramucosal carcinoma) histology; lesions with invasive carcinoma on initial or final histology were excluded. SR patients were identified via a query of the institutional data warehouse and EMR patients via a prospectively collected endoscopic database. Potential patient and polyp predictors of CCP management were analyzed. Results: A total of 180 patients (51.1% male, mean age 64.1y±10.3) were included in the study; 117 (65%) were initially referred for EMR and 63 (35%) for SR. Patients initially referred to SR instead of EMR (Table) were more likely to have a larger polyp size on initial colonoscopy (p