Biopsy forceps is inadequate for the resection of diminutive polyps

Abstract

Within the limitations of a modest sample size, CBP appears to be inadequate treatment for the removal of diminutive polyps.

Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps

“…Several recent studies examined microscopically the presence of residual lesions after CFP by observing specimens obtained immediately by biopsy or endoscopic mucosal resection of post-CFP ulcer edges. The incomplete resection rate ranged from 8 to 38 % [8][9][10][11]. Although these studies revealed a high rate of incomplete resection immediately after CFP of diminutive polyps, that does not necessarily mean that this rate is exactly the same as the real adenoma recurrence rate during follow-up because mechanical disruption of microvasculature and intercellular cohesiveness by CFP could theoretically lead to a loss of residual adenoma tissue.…”

“…Those whose polyps were removed by any technique other than standard CFP were excluded. We also excluded those who had (1) 3 or more polyps; (2) polyps over 5 mm; (3) significant symptoms of colorectal disease (e.g., rectal bleeding); (4) colorectal examinations such as sigmoidoscopy, colonoscopy, and/or barium enema within the previous 5 years; (5) a history of colorectal surgery or colorectal disease such as cancer or inflammatory bowel disease; (6) a history of colorectal cancer in first-degree relatives; (7) sessile serrated adenomas/polyps (SSA/P) removed; (8) colonoscopy that failed to reach the cecum; or (9) poor bowel preparation.…”

“…Despite the widespread use of standard CFP, there have been only a few studies of the clinical efficacy of this technique, and most of these raised concerns about incomplete polyp eradication [8][9][10][11]. In nonblind prospective studies performed by only one or two experienced endoscopists, microscopic incomplete polyp resection rate ranged from 8 to 38 % [8,10,11].…”

S3-Leitlinie – Kolorektales Karzinom

“…Die aktuelle WHO-Definition (26) Die einzelnen Verfahren sind ausführlich in der S2k-Leitlinie der DGVS zu Qualiätsanforderungen der gastrointestinalen Endoskopie [415] diskutiert. Für kleine Polypen bis 5 mm wurde gezeigt, dass die Abtragung mit der Zange oft Adenomgewebe zurücklässt [521] und vermutlich abhängig von der Sorgfalt und der Biopsiezahl ist. Am besten ist die Kaltschlingenabtragung untersucht; sie ist wohl bei kleinen Polypen vorzuziehen [522 -524].…”

Small Colorectal Polyps

“…Efthymiou et al [18] demonstrated that diminutive polyps cannot be removed sufficiently with repeated cold biopsy. By applying endoscopic mucosal resection after repeated cold biopsies until no polyp tissue was visible, only 39% of the diminutive polyps were completely resected.…”