A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps

Park, Soo-Kyung; Ko, Bong Min; Han, Jae Pil; Hong, Su Jin; Lee, Moon Sung

doi:10.1016/j.gie.2015.08.053

Cited by 69 publications

(57 citation statements)

References 26 publications

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“…We only used the two types of snares that are approved for cold resection in Japan; thus, our results may not be applicable to other snares. In this study, we did not assess the amount of time required using each of the two techniques for complete polyp resection in each colonoscopy because the time for polypectomy did not differ between cold forceps polypectomy as almost same technique of HFB and CSP in a previous study[16]. We did not compare the two procedures.…”

Section: Discussionmentioning

confidence: 99%

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

WJG

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AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.METHODSThis prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely performed.RESULTSTwo hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

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Section: Discussionmentioning

confidence: 99%

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

WJG

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“…Thus, currently, CSP has gained notoriety. Moreover, the incidence of DPPB was reported to be 0 % to 1.8 % for CSP in previous prospective studies 15 16 17 18 19 , which tends to be lower than that of HP even in patients that continued to receive anticoagulant treatment 17 . However, a previous study included only a small number of patients, and few studies have compared the incidence of DPPB of CSP and HP in daily clinical setting.…”

Section: Introductionmentioning

confidence: 91%

Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

et al. 2017

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Background and study aims Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis. Patients and methods This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015. Results There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, P = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, P = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, P < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, P = 0.01). Conclusions DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.

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“…Recent studies by Park et al [7] and Kim et al [10] also showed that the cold-snare technique consistently achieved higher complete resection rates for polyps 5–7 mm in size than cold forceps. This finding agrees with that of Urquhart and Brown [9] who found that a cold snare can be consistent in achieving a complete resection of sessile polyps when a 1- to 2-mm rim of normal mucosa around the polyp is also resected.…”

Section: Discussionmentioning

confidence: 98%

“…This guideline highlights the need for adequate regulations regarding polyp resection. A study by Park et al [7] showed that removal of polyps 1–3 mm in size by cold forceps had the same outcome as those removed by cold-snare resection, but that cold-forceps polypectomy is likely to be insufficient for larger polyps. On the other hand, cold-snare techniques reduce the risk of incomplete diminutive polyp removal by as much as 60%, without increasing the total procedure time [8].…”

Section: Introductionmentioning

confidence: 99%

Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

Parihar

Sopheno-Falco

Maheshwari

et al. 2018

Gastrointest Tumors

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Background and Study Aim: The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice. Patients and Methods: This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded. Results: 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to. Conclusions: This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.

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A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps

Cited by 69 publications

References 26 publications

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

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