Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?

Britto-Arias, Martha; Waldmann, Elisabeth; Jeschek, Philip; Gessl, Irina; Sallinger, Daniela; Bannert, Christina; Weber, Michael; Trauner, Michael; Weiss, Werner; Ferlitsch, Arnulf; Ferlitsch, Monika

doi:10.1055/s-0034-1392328

Cited by 23 publications

(17 citation statements)

References 21 publications

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“…Studies prior to the issuing of the guidelines show a significantly higher rate of inappropriate forceps use, sometimes as high as 46%; studies show a decrease of 14.2% in inappropriate forceps use in hospitals since the new guidelines came into place [3]. This is in keeping with our data.…”

Section: Discussionsupporting

confidence: 90%

“…The adenoma (as well as the serrated adenoma sequence of colorectal carcinogenesis) lends itself to screening and surveillance, albeit at differing intervals [2]. Studies have shown that the complete removal of colonic polyps during colonoscopy reduces the incidence of CRC [3]. It has also been estimated that incomplete resection is involved in 19–31% of interval cancers [3].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown that the complete removal of colonic polyps during colonoscopy reduces the incidence of CRC [3]. It has also been estimated that incomplete resection is involved in 19–31% of interval cancers [3]. Studies have shown that, 10–15% of the time, residual polypoid tissue can be found at the post-polypectomy site [4, 5].…”

Section: Introductionmentioning

confidence: 99%

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Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

Parihar

Sopheno-Falco

Maheshwari

et al. 2018

Gastrointest Tumors

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Background and Study Aim: The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice. Patients and Methods: This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded. Results: 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to. Conclusions: This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

Parihar

Sopheno-Falco

Maheshwari

et al. 2018

Gastrointest Tumors

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“…A study on Austrian hospitals shows that adherence to the guidelines for colorectal cancer screening was worse among private hospitals. After the implementation of a guideline for colorectal screening, only 3.8% of private hospitals changed their routine practice versus 14.2% of public hospitals …”

Section: Resultsmentioning

confidence: 99%

“…After the implementation of a guideline for colorectal screening, only 3.8% of private hospitals changed their routine practice versus 14.2% of public hospitals. 56…”

Section: Processmentioning

confidence: 99%

Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review

Kruse

Stadhouders

Adang

et al. 2018

Health Planning & Management

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SummaryEuropean countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social‐economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for‐profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.

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Cold snare polypectomy vs cold forceps biopsy in endoscopic treatment of colonic small and diminutive polyps—Effectiveness and safety in the real world

Chien

Huang

et al. 2018

Adv in Digestive Medicine

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The practice of colonoscopy is used to reduce the risk of colonic malignancy. Complete removal of polyps is required to prevent tumor recurrence and the development of potential interval cancers. However, it is difficult to completely remove the polyp that is more than 4 mm in size through cold forceps biopsy. Polypectomy with a cold snare has been increasingly utilized in recent years, which provides a chance of complete removal of the polyp. This study compares the effectiveness and safety between cold snare polypectomy (CSP) and cold forceps biopsy (CFB) in diminutive or small sessile polyp removal. Between August 2015 and June 2016, 164 consecutive patients with colorectal polyps <10 mm in size were enrolled into either the CSP or CFB group. Demographic data, the duration of colonoscopy withdrawal time, adverse events, and pathological reports were recorded. The primary outcome is complete polyp eradication histologically. The secondary outcomes include rates of adverse events and time taken for the procedures. Of 164 patients, 84 patients were in CSP group and 80 patients in CFB group. The CSP group comprised elder patients (P = 0.042), most of who were male (P = 0.359). There was no significant difference of indications for colonoscopy. The mean withdrawal time was significantly longer in the CSP group (12.5 ± 6.90 minutes vs 9.14 ± 5.45 minutes; P < 0.01). The mean polyp size was bigger in the CSP group (5.05 ± 2.72 mm vs 3.84 ± 1.52 mm, P < 0.05). Eighty‐nine (84.7%) adenomas, 13 (12.4%) hyperplastic polyps, and three other polyps (2.9%) were resected in the CSP group. No high‐grade dysplasia or malignancy was found. Pathological examination showed that 54 polyps were completely removed in CSP group. Thirteen polyps were not removed completely, and 38 polyps could not be surveyed due to tissue destruction during the procedure. In the CFB group, no polyps could be identified with complete removal. The complete histological polyp eradication rate is higher in the CSP group (51.4% vs 0%, P < 0.01). Under operator's discretion, 23 cases with 31 hemoclips were applied for bleeding prevention in the CSP group and only one in the CFB group. However, no further treatment requirement or delayed bleeding event was found in both groups. CSP is an effective method in small or diminutive polyps compared with CFB, and its safety is not inferior to CFB. Given these results and the high prevalence of such polyps, CSP is advocated as an alternate treatment.

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Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?

Abstract: This study confirmed the importance of the European guidelines. The inclusion of adequate resection technique as a quality indicator in colorectal cancer screening programs is recommended.

Cited by 23 publications

References 21 publications

Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital

Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review

Cold snare polypectomy vs cold forceps biopsy in endoscopic treatment of colonic small and diminutive polyps—Effectiveness and safety in the real world

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