Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection

Toyosawa, Junki; Yamasaki, Yasushi; Fujimoto, Tsuyoshi; Tanaka, Shouichi; Tanaka, Takehiro; Mitsuhashi, Toshiharu; Okada, Hiroyuki

doi:10.1055/a-1785-8616

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…This indicates that UEMR has superior vertical resectability. Our findings mirror a previous report in colorectal polyps demonstrating that CSP results in shallower resection depth than hot snare polypectomy or UEMR (35,36). Moreover, the median thickness of the submucosal layer in the UEMR group (546 μm) is highly indicative of sufficient resectability given the definitions of submucosal deep invasion for other gastrointestinal carcinomas (esophagus 200 μm, stomach 500 μm, and colon 1,000 μm).…”

Section: Discussionsupporting

confidence: 91%

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy

Miyazaki,

Nakayama,

Sasaki

et al. 2024

Am J Gastroenterol

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INTRODUCTION: Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial non-ampullary duodenal epithelial tumors (SNADETs). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability. METHODS: In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADETs ≤ 12 mm were randomly allocated to UEMR and CSP groups. The primary endpoint was sufficient vertical R0 resection (SVR0) which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups. RESULTS: The SVR0 rate was significantly higher in the UEMR group than in the CSP group (65.6% vs. 41.5%, P = 0.01). By contrast, the R0 resection rate was not significantly different between study groups (70.3% vs. 61.5%, P = 0.29). The submucosal layer thickness was significantly greater in the UEMR group than in the CSP group (median 546 [range, 309-833] µm vs. 69 [0-295] µm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8-16] min vs. 1 [1-3] min, P < 0.01) and fewer total bleeding events (9.4% vs. 1.5%, P = 0.06). CONCLUSION: UEMR has superior vertical resectability compared to CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADETs, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias.

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Section: Discussionsupporting

confidence: 91%

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy

Miyazaki,

Nakayama,

Sasaki

et al. 2024

Am J Gastroenterol

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“…Nevertheless, there is an ongoing debate regarding the predictability of muscularis mucosa resection. Previously published studies observed that muscularis mucosa was absent in 27.8% of excision specimens, while its presence ranged from 57-92%, even in cases involving cold snare polypectomy with submucosal injection [ 24 - 27 ]. The COLDWATER study revealed a significantly higher muscularis mucosa resection rate for UCSP (UCSP: 81.72±62.81%, CCSP: 72.33± 22.33%, P=0.003), suggesting a more favorable efficacy profile.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of submucosa has been observed in 9-24% of resected specimens following CCSP [ 24 , 26 , 30 ]. However, our study revealed a superficial depth of excision, with only 16.6% and 12.5% of specimens including submucosa in UCSP and CCSP (P=0.25), respectively.…”

Section: Discussionmentioning

confidence: 99%

Results of the COLDWATER randomized controlled trial: enhanced performance of underwater cold snare polypectomy for colorectal polyps 5-10 mm, independent of endoscopist experience

Zachou

2024

aog

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Background The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety. Methods This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for non-pedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the muscularis mucosa resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, en bloc resection rate, adverse events, and recurrence rate. Results The COLDWATER study found higher muscularis mucosa resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and en bloc resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than non-experts, while UCSP showed no significant difference in R0RR across endoscopist’s experience levels. Conclusions UCSP achieves a more extensive excision of the muscularis mucosa compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher en bloc resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection.

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“…Some endoscopists may have difficulty achieving universal cold snare resection of polyps ≤10 mm in size, but we have demonstrated the potential benefit achievable by striving for universal cold snare resection of polyps ≤10 mm. We note cold snaring is inappropriate when endoscopic inspection leads to cancer suspicion, because cold snaring cuts superficially compared with hot snaring [14,15,16]. We previously demonstrated extremely low invasive cancer risk in lesions ≤10 mm [17], and there were no invasive cancers ▶ Table 3 Fraction of patients with various different size polyps and managed entirely by cold snaring in the different size groups, by indication.…”

Section: Discussionmentioning

confidence: 99%

One-device colonoscopy: feasibility, cost savings, and plastic waste reduction by procedure indication, when performed by a high detecting colonoscopist

Rex,

Gallagher,

Lahr

et al. 2023

Endoscopy

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Background and study aim Cold forceps and snares are each effective for removing 1-3 mm polyps while snares are more effective for 4-10 mm polyps. If 1-3 mm polyps are removed with forceps and 4-10 mm polyps with snares in the same patient, two devices are used. If cold snares are used to resect all lesions 1-10 mm (one-device colonoscopy), there is potential for lower cost and less plastic waste. Patients and Methods A single high detecting colonoscopist prospectively measured the feasibility of cold snaring all colorectal lesions ≤ 10 mm in size, and the associated cost and plastic waste reduction. Results 677 consecutive lower endoscopies not for inflammatory bowel disease were assessed. Of 1430 lesions 1-3 mm and 1685 lesions 4-10 mm in size, 1428 (99.9%; 95% CI, 99.5%-100.0%) and 1674 (99.3%; 95% CI, 98.8%-99.7%) were successfully resected using cold snare, respectively. Among 379 screening and surveillance patients, universal cold snaring of lesions ≤ 10 mm saved 35 and 47 cold forceps per 100 screening and surveillance patients, respectively. Conclusion Cold snare resection of all lesions ≤ 10 mm (“one-device colonoscopy”) was feasible and reduced cost and plastic waste.

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Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection

Cited by 8 publications

References 33 publications

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy

Results of the COLDWATER randomized controlled trial: enhanced performance of underwater cold snare polypectomy for colorectal polyps 5-10 mm, independent of endoscopist experience

One-device colonoscopy: feasibility, cost savings, and plastic waste reduction by procedure indication, when performed by a high detecting colonoscopist

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