Endoscopic management of colorectal tumors less than 10 mm in size: Current status and future perspectives in Japan from a questionnaire survey

Uraoka, Toshio; Oka, Shiro; Ichihara, Shin; Iwatate, Mineo; Tamai, Naoto; Kawamura, Takuji; Takeuchi, Yoji; Mori, Yuichi; Yoshii, Shinji; Hashimoto, Shinichi; Ho, Shiaw Hooi; Chiu, Han‐Mo

doi:10.1111/den.13060

Cited by 14 publications

(18 citation statements)

References 11 publications

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“…Many studies have reported the therapeutic results and adverse events of CSP. [1][2][3][4][5][6] However, there have been few reports about follow-up after CSP for lesions ≥10 mm in size. In a previous study, we showed that the rates of recurrence after CSP for 480 lesions <10 mm and 74 lesions 10-14 mm were 1.4% and 5.4%, respectively (p = 0.06).…”

Section: Discussionmentioning

confidence: 99%

“…Cold snare polypectomy (CSP) is an endoscopic treatment which does not need an electrosurgical unit, and its use is spreading rapidly across the world because of its safeness and convenience, as CSP does not cause perforation and is associated with a low risk of postoperative haemorrhage, even in patients taking antith-rombotic drugs. [1][2][3][4][5] However, the indications for CSP are limited to benign lesions <10 mm in size, such as sessile serrated lesions (SSLs) and adenomas, because tumours ≥10 mm in size are more likely to be cancerous lesions than tumours <10 mm in size. 2,6,7 Operators have to differentiate benign lesions from cancerous lesions by white light image (WLI) and magnifying narrow-band imaging (NBI) or blue laser imaging (BLI).…”

Section: Introductionmentioning

confidence: 99%

“…2,6,7 Operators have to differentiate benign lesions from cancerous lesions by white light image (WLI) and magnifying narrow-band imaging (NBI) or blue laser imaging (BLI). 2,8,9 Additionally, our previous study showed that the rate of local recurrence after CSP for polyps ≥10 mm was higher than that for polyps <10 mm. 10 Thus, CSP is not regularly recommended for neoplastic lesions ≥10 mm.…”

Section: Introductionmentioning

confidence: 99%

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Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

et al. 2021

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Background and aim Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. Methods This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10–20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10–14 mm in size to those for lesions 15–20 mm in size. Results We analysed 160 lesions in 100 patients ( Mage± SD=67.7±10.1 years). The polyp size ( M± SD) was 11.8±2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12–24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10–14 mm in size and 15–20 mm in size were 4.7% and 6.3%, respectively ( p=0.713). Conclusion CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

et al. 2021

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“…Polyp size is used in many guidelines to propose postpolypectomy surveillance interval, as well as polyp number and histology 1,2. In addition, the recommended endoscopic resection procedures for colorectal tumors have been shown, according to the polyp size 3. Inaccurate polyp size assessment results in the recommendation of incorrect surveillance intervals and treatment methods, which may increase the risk of colorectal cancer or lead to an unnecessary invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

Short educational video to improve the accuracy of colorectal polyp size estimation: Multicenter prospective study

Utsumi¹,

Horimatsu

Nishikawa

et al. 2020

Digestive Endoscopy

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Background and Aim Accurate polyp size estimation is necessary for appropriate management of colorectal polyps. Polyp size is often determined by subjective visual estimation in clinical situations; however, it is inaccurate, especially for beginner endoscopists. We aimed to clarify the usefulness of our short training video, available on the Internet, for accurate polyp size estimation. Methods We conducted a multicenter prospective controlled study in Japan. After completing a pretest composed of near and far images of 30 polyps, participants received the educational video lecture (<10 min long). The educational content included the knowledge of strategies based on polyp size and criteria for size estimation including the endoscopic equipment size and videos of polyps in vivo. After one month, the participants undertook a posttest. The primary outcome was a change in the accuracy of polyp size visual estimation between the pretest and posttest in beginners. Results Participants including 111 beginners, 52 intermediates, and 97 experts from 51 institutions completed both tests. Accuracy of polyp size estimation in the beginners showed a significant increase after the video lecture [54.1% (51.3–57.0%) to 59.0% (56.5–61.5%), P = 0.003]. Multivariable logistic regression analysis showed that the category of beginners and a low score on pretest (P = 0.020 and <0.001, respectively) were the factors that contributed to an increase of ≥10% in the accuracy. Conclusion Our educational video led to an improvement in polyp size estimation in beginners. Furthermore, this video may be useful for non‐beginners with insufficient polyp size estimation accuracy.

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“…The proposed management paradigm for colorectal polyps, including endoscopic surveillance intervals, depends on the size as well as the qualitative assessment of colorectal polyps. 1,2 Although endoscopists are asked to accurately assess polyp size, some studies have shown a bias in the measurement of colorectal polyp size at colonoscopy. 3 We evaluated the distribution of colorectal polyp size by endoscopic estimation and investigated the presence of measurement bias in Japan.…”

mentioning

confidence: 99%

Measurement bias of colorectal polyp size: Analysis of the Japan Endoscopy Database

Utsumi

Horimatsu

Seno

2019

Digestive Endoscopy

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Endoscopic management of colorectal tumors less than 10 mm in size: Current status and future perspectives in Japan from a questionnaire survey

Cited by 14 publications

References 11 publications

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

Short educational video to improve the accuracy of colorectal polyp size estimation: Multicenter prospective study

Measurement bias of colorectal polyp size: Analysis of the Japan Endoscopy Database

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