Multidisciplinary team (MDT) meetings are established as the standard of care in clinical pathways, ensuring that each patient receives the best management through a coordinated and evidence-based multidisciplinary assessment. This study aimed to assess the influence of MDT discussions on care pathways and their effect on patient outcomes.

The Advanced-Endoscopy MDT was introduced in our Institution in 2021 to review complex luminal endoscopic cases. Weekly meetings are attended by a core consultant body including 2 interventional endoscopists, 1 GI radiologist, 1 colorectal surgeon, 1 histopathologist and 1 MDT coordinator. Endoscopic and radiological images, as well as histopathological specimens, are reviewed to recommend the best management plan. Patients are reviewed in the outpatient clinic after MDT review to discuss the benefit and risk of MDT recommendation and again after the intervention to discuss the results and further management. All cases discussed between 16^th of September 2024 – 16^th of September 2025 were reviewed. Demographic, clinical, endoscopic findings, and outcome data were analysed.

300 cases (136 patients) were discussed over 45 meeting; 86,7% of these were discussed at least twice. Patients were referred for colonic lesions (84 patients, 61.8%), small bowel disease (29 patients, 21,6%), gastric lesions (9 patients, 6,6%) or second opinion for GI assessments (14 patients, 10%). Most referrals (88.9%) originated internally from the Royal Free Hospital, while 11.1% referred from other hospitals.

Colonic lesions discussed in the MDT were treated in 93,9%, mostly with endoscopic submucosal dissection (ESD, 82,9%), achieving an R0 resection of 92,6%. 6.1% of the patients that were not treated (one seeks a second opinion in another centre, one had a synchronous metastatic bowel cancer, and conservative management due to advanced age and complex previous medical history was adopted in other 2 cases).

Nine patients referred with gastric lesions were discussed and referred for endoscopic resection, either by ESD (5) or EFTR (2) or en-bloc EMR (2); R0 resection was achieved in all cases. Twenty-nine complex small bowel cases were discussed at the MDT and 72,4% were referred for double balloon enteroscopy (DBE): 71,4% for suspected small bowel lesions, 14,3% for small bowel bleeding, 9,5% for anaemia, and 4,8% for a capsule retention. 24% required additional evaluation with SBCE or further radiological imaging.

After  endoscopy MDT discussion, eleven patients were referred from the endoscopy MDT to other MDTs: six cases were referred to the NET MDT, one to the Anal MDT, one to the Respiratory Team, one to the Upper GI Cancer MDT (UCLH), and two to genetic assessment. In addition, two further patients were referred straight for surgery: one with a gastric neuroendocrine tumour not amenable to endoscopic resection and one patient with sigmoid cancer and liver metastases.

No major complications were recorded. No complaints related to any of these patients were reported.

These results suggest that the Advanced-Endoscopy-MDT improves patient care and safety through a stronger hospital governance. In addition, dedicated luminal therapeutical endoscopic pathway, promotes an efficient flow of patients both internally with other MDTs and externally with other Institutions. The MDT structure ensured appropriate referrals and coordinated care, offering a safe and satisfactory experience for patients.