Factors Associated with possibly Inappropriate Histological Evaluation of Excised Specimens in Cold-snare Polypectomy for Small Colorectal Polyps

Shimodate, Yuichi; Itakura, Junya; Mizuno, Motowo; Takezawa, Rio; Kobayashi, Mami; Yamazaki, Tatsuhiro; Doi, Akira; Nishimura, Naoyuki; Mouri, Hirokazu; Matsueda, Kazuhiro; Yamamoto, Hiroshi

doi:10.15403/jgld.2014.1121.271.hst

Cited by 18 publications

(23 citation statements)

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“…The pathological unclear resected margin is often reported as incomplete resection, and this is often discussed in CSP because of its high rate. 11,[18][19][20][21] The rate of the unclear cutend of <10 mm lesions was reported to be higher in CSP than in EMR (35.6% vs. 10.1%). 10 Our study also showed that the unclear cut-end rate was not significant but higher in CSP than EMR (13.7% vs. 7.4%; Table S3).…”

Section: Discussionmentioning

confidence: 96%

“…The pathological unclear resected margin is often reported as incomplete resection, and this is often discussed in CSP because of its high rate 11,18–21 . The rate of the unclear cut‐end of <10 mm lesions was reported to be higher in CSP than in EMR (35.6% vs. 10.1%) 10 .…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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. A study showed that the removal of the suction valve button may reduce the fragmentation.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…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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Underwater versus conventional cold snare polypectomy of colorectal polyps 4–9 mm in diameter: a prospective randomized controlled trial

et al. 2022

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Factors Associated with possibly Inappropriate Histological Evaluation of Excised Specimens in Cold-snare Polypectomy for Small Colorectal Polyps

Abstract: Incomplete muscularis mucosae resection and fragmentation at retrieval are risk factors for inadequate histological evaluation of CSP-excised small colorectal polyps, especially for sessile polyps and polyps in the cecum.

Cited by 18 publications

References 0 publications

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

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

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

Underwater versus conventional cold snare polypectomy of colorectal polyps 4–9 mm in diameter: a prospective randomized controlled trial

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