Challenges associated with the pathological diagnosis of colorectal tumors less than 10 mm in size

Ichihara, Shin; Uraoka, Toshio; Oka, Shiro

doi:10.1111/den.13038

Cited by 9 publications

(20 citation statements)

References 21 publications

(32 reference statements)

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“…9 Regarding the efficacy of CSP, an analysis based on colonic polyps sized ≤10 mm reported that polyp retrieval failure occurred in 7% of CSP cases. 10 Histologically, unclear margins were observed in 36% of CSP cases for which pathological diagnosis was possible. 10 Another study on colonic polyps reported that only 2% of CSP samples included the submucosa.…”

Section: Cold Snare Polypectomy For Nadetsmentioning

confidence: 99%

“…10 Histologically, unclear margins were observed in 36% of CSP cases for which pathological diagnosis was possible. 10 Another study on colonic polyps reported that only 2% of CSP samples included the submucosa. 11 Therefore, there are still concerns about the application of CSP for high-grade adenomas or carcinomas that need resection including the submucosal tissue.…”

Section: Cold Snare Polypectomy For Nadetsmentioning

confidence: 99%

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Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

et al. 2020

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Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses. Clin Endosc 2020 Jan 15.

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Section: Cold Snare Polypectomy For Nadetsmentioning

confidence: 99%

Section: Cold Snare Polypectomy For Nadetsmentioning

confidence: 99%

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

et al. 2020

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“…37 In addition, failure of polyp retrieval and fragmentation of small specimens during collection was associated with the effects Cold snare polypectomy 375 of certain parameters on the pathological diagnosis, particularly with regard to surgical margins. 38,39 Therefore, an endoscopy biomarker of effective and safe cold snare polypectomy technique needs to be established in terms of complete removal of non-pedunculated colorectal polyps ≤10 mm.…”

Section: Future Of Cold Snare Polypectomymentioning

confidence: 99%

“…Another cold snare polypectomy study found that 27.8% of excised polyps that were 2–14 mm in diameter did not contain muscularis mucosae, implying incomplete resection for larger polyps in the vertical margins . In addition, failure of polyp retrieval and fragmentation of small specimens during collection was associated with the effects of certain parameters on the pathological diagnosis, particularly with regard to surgical margins . Therefore, an endoscopy biomarker of effective and safe cold snare polypectomy technique needs to be established in terms of complete removal of non‐pedunculated colorectal polyps ≤10 mm.…”

Section: Future Of Cold Snare Polypectomymentioning

confidence: 99%

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

Horiuchi

Ikuse

Tanaka

2019

Digestive Endoscopy

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Colonoscopy has been shown to reduce the risk of colon cancer by enabling the removal of precancerous lesions. Although cold snare and hot snare polypectomy have similar retrieval rates and complete resection rates, rates of delayed bleeding tend to be lower with cold snare polypectomy than with hot snare polypectomy, especially for patients taking antithrombotic agents. However, among cold snares there may be differences in terms of the completeness of polyp excision, as complete removal appears more likely with thin‐wire dedicated cold snares compared to the traditional, thick‐wire cold snares. Cold snare polypectomy may be especially well suited for use in patients taking antithrombotic agents, due to its minimal risk of delayed bleeding. Histological analyses suggest that cold snare polypectomy causes less damage to blood vessels in the submucosal layers, which results in a reduced incidence of hemorrhage compared to hot snare polypectomy. However, cold snare removal of small polyps may result in fragmentation of small specimens during collection and concerns as to whether the resection is complete. An endoscopy biomarker of effective cold snare polypectomy technique is needed to ensure complete removal of non‐pedunculated colorectal polyps ≤10 mm. Future uses of cold snare polypectomy may include piecemeal removal of sessile serrated adenoma/polyp lesions >10 mm. Currently, cold snare polypectomy should be considered a primary method for colorectal polyps of less than 10 mm, especially those in the 4‐ to 10‐mm range.

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“…Several possible factors are suspected for the pathological diagnosis of unclear cut‐end or NNP, such as the processes of polyp resection, polyp retrieval, and pathological sample manufacturing 9 . Considering the polyp retrieval factors, specimen retrieved by suctioning through the suction channel is often fragmented even if en bloc resection was achieved, which may affect the pathological evaluation 10,11 . At this point, we focused on the suction valve, which is one of the most intricate parts in the endoscope.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis

Kishida

Imai

Ito

et al. 2020

Digestive Endoscopy

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Background and Aim Fragmentation of endoscopically resected colorectal polyps during retrieval is one of the limitations for appropriate pathological diagnosis; however, little is known about steps to reduce it. We aimed to evaluate the effect of removing the suction valve button, which is one of the intricate parts of the endoscope, during polyp suction retrieval for fragmentation and pathological diagnosis. Methods We retrospectively reviewed the polyps retrieved by suctioning. We used the propensity score matching method to adjust for difference between the button‐attached and button‐removed groups. Outcomes of fragmentation, pathological diagnosis of non‐neoplastic polypectomy (NNP), and pathological cut‐end among neoplastic lesions were evaluated. Results On the basis of propensity score matching, 322 pairs of cases were selected for analysis. After matching, the difference in the variables between the two groups was closely balanced. The fragmentation rate was significantly different between the groups (button‐attached 36.6% vs. button‐removed 22.4%, P < 0.001). No significant difference in the NNP rate was observed between the two groups (button‐attached 8.4% vs. button‐removed 9.9%). The rate of unclear cut‐end was lower in the button‐removed group than in the button‐attached group (16.2% vs. 9.1%, P = 0.010). In the multivariate analysis, button removal was independently associated with reductions of fragmentation (odds ratio [OR] 0.508, P < 0.001) and unclear cut‐end (OR 0.503, P = 0.009). Also, NNP was associated with smaller lesion size (OR 0.364, P < 0.001), but not with button removal. Conclusions Suction valve button removal during polyp suction retrieval was an effective method to decrease the rates of fragmentation and histological unclear margins.

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Challenges associated with the pathological diagnosis of colorectal tumors less than 10 mm in size

Cited by 9 publications

References 21 publications

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis

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