Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Abstract

AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.METHODSThis prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely performed.RESULTSTwo hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

“…Based on the title and abstract, 816 irrelevant studies were excluded. Evaluation of the full text of the remaining studies excluded eight more: observational studies ( n = 4), comparison with cold forceps ( n = 3) and comparison with hot forceps ( n = 1) . The remaining eight studies were included in this meta‐analysis …”

“…Evaluation of the full text of the remaining studies excluded eight more: observational studies (n = 4), [8][9][10][11] comparison with cold forceps (n = 3) 12-14 and comparison with hot forceps (n = 1). 15 The remaining eight studies were included in this meta-analysis. 2,5,[16][17][18][19][20][21]…”

Best Polypectomy Technique for Small and Diminutive Colorectal Polyps: A Systematic Review and Meta-Analysis

“…Cold snare polypectomy was significantly superior to hot forceps regarding complete and en-bloc resection rates (RD 0.33, 95%CI 0.22 to 0.44 and RD 0.19, 95%CI 0.12 to 0.26, respectively) as compared on the single study performed by Komeda et al (23) . The NNT for complete resection was 3.…”

“…We created this subgroup analysis comprising six studies to compare all cold polypectomy techniques versus all hot procedures (18)(19)(20)23,32,33).…”

“…Only two trials compared en-bloc resection rate (23,32) . This analysis also found high heterogeneity (I²=97%) and no statistical difference between cold and hot polypectomy (RD=0.06, 95% CI -0.20 to 0.32) (FIGURE 7B).…”