Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

Hirose, Ryohei; Yoshida, Naohisa; Murakami, Takaaki; Ogiso, Kiyoshi; Inada, Yutaka; Dohi, Osamu; Okayama, Tetsuya; Kamada, Kazuhiro; Uchiyama, Kazuhiko; Handa, Osamu; Ishikawa, Takeshi; Konishi, Hideyuki; Naito, Yuji; Fujita, Yuka; Kishimoto, Mitsuo; Yanagisawa, Akio; Itoh, Yoshito

doi:10.1111/den.12825

Cited by 51 publications

(64 citation statements)

References 25 publications

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“…16 Biopsy from mucosal defect or CSDP contained muscularis mucosa in 38% in our study. Because, complete removal of the entire mucosal layer is important to avoid recurrence after CSP for small cancers invading the muscularis mucosa, which can be completely removed with endoscopic mucosal resection following submucosal injection.…”

Section: Discussionmentioning

confidence: 54%

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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Section: Discussionmentioning

confidence: 54%

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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“…We think this trend should be changed in the future. In addition, some studies have shown that CP is useful for removing polyps of more than 10 mm in size [22-24]; however, some of those reports recommend piecemeal polypectomy. The reported rate of incomplete resection by CP was 3.9% [25] and there is a report of recurrence after CP [26]; thus, careful consideration for the indication of size is necessary.…”

Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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“…A total of 126 lesions were removed using CSP, but there was no adverse event [27]. In histological analysis of colorectal polyps removed by CSP, the muscularis mucosae were not resected in 27.8% of patients [28]. Thus, further studies are needed to evaluate the effectiveness of CSP for small SNADETs, especially regarding the lesion residue and recurrence.…”

Section: Characteristics and Treatment Outcome Of Each Er Methodsmentioning

confidence: 99%

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2018

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Background: Endoscopic resection (ER) is becoming the first choice of treatment for treating superficial nonampullary duodenal epithelial tumors (SNADETs), but ER procedures for SNADETs remain challenging because of the difficulty experienced in maneuvering the endoscope toward the thin duodenal wall, which results in a high rate of adverse events. Although several ER methods were used to overcome these technical difficulties and complications, ER methods for SNADETs are not standardized. A new technique, underwater endoscopic mucosal resection (UEMR), was developed recently in a western country, and its usefulness was reported. Beginning in 2014, we were the first to use UEMR for SNADETs in Japan. Thus, in our experience, we would propose an indication of the various ER methods for SNADETs according to the lesion size. Summary: Endoscopic mucosal resection (EMR) and UEMR were effective and safe for small lesions (≤20 mm), but for large lesions (>20 mm), piecemeal removal of lesion by EMR and UEMR had high incidence of recurrence and adverse events. Especially, piecemeal EMR could cause delayed perforation. Cold snare polypectomy was useful for small lesions (≤10 mm), but further study of its recurrence is warranted. Endoscopic submucosal dissection (ESD) achieved a high complete resection rate regardless of the lesion size, but its rate of adverse events, including morbid complications, was high. Thus, after ESD for large lesions, secure prevention method for adverse events, such as closure of the wound by laparoscopic-endoscopic cooperative surgery, should be required. Key Messages: ER methods for treating SNADETs were proposed based on the lesion size. For large lesions, prophylactic methods for adverse events should be implemented.

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Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

Abstract: CSP is a safe procedure for polyps 2-14 mm. However, CSP has limitations in terms of the histopathological margin and loss of muscularis mucosa in specimens.

Cited by 51 publications

References 25 publications

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

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

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

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