Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

Abstract

Background/Aims There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later. Methods We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed. Results The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience. Conclusions CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.

Prospective multicenter study of the efficacy and safety of cold forceps polypectomy for ≤ 6-mm non-ampullary duodenal low-grade adenomas

“…In this study, we used standard-size forceps to assess the risk of duodenal perforation. However, data on outcomes with CFP for colorectal adenoma using jumbo forceps are favorable [9] suggest that perforation of the digestive tract may not be a consideration with use of large forceps. However, the efficacy of use of jumbo biopsy forceps should be verified, given the potential to further shorten procedure time and number of biopsies.…”

“…There have been some reports about the efficacy and safety of cold forceps polypectomy (CFP) and cold snare polypectomy (CSP) for diminutive colorectal polyps 9 10 11 12 13 14 . A single study revealed the safety and effectiveness of cold polypectomy for NADA 15 ; however, most of the patients in that study underwent CSP, and there are no clear data about CFP.…”

The quality of colorectal polypectomy. Is it enough to have just a visual assessment of the site?

“…Although the study was rather limited, the data is concerning regarding complete polyp resection by simply using biopsy forceps [ 13 ]. On the other hand, in a more recent study from 2019, Hasegawa et al assessed the resection of diminutive polyps using jumbo cup forceps in a larger study with 361 patients and 573 adenomas and concluded that this technique was safe for complete one-bite resections [ 14 ].…”

Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

“…Delayed PPB was defined as the presentation of melena or hematochezia within 30 days of the colonoscopic procedure, with the symptoms requiring hospitalization or a hemostasis procedure. 21 , 22 Clinical outcomes related to PPB following the colonoscopic removal of colorectal polyps, including need for colonoscopic hemostasis, surgical intervention, and mortality, were also evaluated.…”