Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Papastergiou, Vasilios; Paraskeva, Konstantina; Fragaki, Maria; Dimas, Ioannis; Vardas, Emmanouil; Theodoropoulou, Anǵeliki; Mathou, Nicoletta; Giannakopoulos, Athanasios; Karmiris, Konstantinos; Mpitouli, Afroditi; Apessou, Dimitra; Giannikaki, Linda; Karagiannis, John A.; Chlouverakis, Gregorios; Paspatis, Gregorios A.

doi:10.1055/s-0043-118594

Cited by 87 publications

(146 citation statements)

References 30 publications

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“…Evaluation of the full text of the remaining studies excluded eight more: observational studies ( n = 4), comparison with cold forceps ( n = 3) and comparison with hot forceps ( n = 1) . The remaining eight studies were included in this meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

“…The studies reviewed were conducted in China, Greece, Japan and the USA . The year of publication ranges from 2011 to 2018, and study periods were from 2008 to 2017.…”

Section: Resultsmentioning

confidence: 99%

“…Type of snare used in each study is listed in Table . One study partially used a dedicated snare for CSP . Each study used a different type of snare, except three studies that used the Captivator II (Boston Scientific, Natick, MA, USA) …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

Shinozaki

Kobayashi

Hayashi

et al. 2018

Digestive Endoscopy

105

145

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Section: Resultsmentioning

confidence: 99%

“…The studies reviewed were conducted in China, Greece, Japan and the USA . The year of publication ranges from 2011 to 2018, and study periods were from 2008 to 2017.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

Shinozaki

Kobayashi

Hayashi

et al. 2018

Digestive Endoscopy

105

145

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show abstract

“…Several studies have evaluated the histological residue after CSP, [25][26][27] but most evaluated lateral-margin residue only. A small number of studies also evaluated vertical margins by collecting biopsies from the CSP defect; however, obtaining precise biopsies from the base of the mucosal defect after CSP is difficult because the mucosal defect after CSP for small polyps is also small.…”

Section: As Indicatedmentioning

confidence: 99%

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Shichijo

Takeuchi

Kitamura

et al. 2019

J of Gastro and Hepatol

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Background and Aim The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). Methods We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. Results From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. Conclusions Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra‐epithelial lesions only, and careful pretreatment evaluation is recommended.

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“…compared polyp retrieval rates and complete resection rates between cold and hot snare polypectomy as a main outcome measure of a meta‐analysis . Polyp retrieval rates have been included in eight studies, of which seven were included with regard to complete resection rates . Cold snare polypectomy had a similar polyp retrieval rate compared with hot snare polypectomy (97% vs 97%, P = 0.60) with no heterogeneity .…”

Section: Outcomes 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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Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Abstract: CS-EMR appears to be a valuable modification of the standard cold snare technique, obviating the need to use diathermy for nonpedunculated colorectal polyps sized 6 - 10 mm.

Cited by 87 publications

References 30 publications

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

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

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