Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps

Lee, Ho‐Su; Park, Hye Won; Lee, Jong Soo; Kim, Jong Cheol; Choe, Jaewon; Soh, Jae Seung; Lee, Seohyun; Bae, Jung-Ho; Lee, Hyo‐Jeong; Yang, Dong Hoon; Myung, Seung Jae; Yang, Suk Kyun; Chang, Hye Sook

doi:10.1007/s00464-016-4947-1

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…The recurrence rate of 2.1 % at 1 year following CFP is acceptably low compared with other polyp resection techniques, such as endoscopic mucosal resection, polypectomy, and hot biopsy [25]. The recurrence rate in the present study was also lower than the only published study that has reported local recurrence (cumulative recurrence rate of 17 % over 5 years) following CFP using standard forceps for diminutive polyps [20]. However, that study was retrospective in nature and the diagnosis of the majority of the recurrent lesions was not definitive.…”

Section: Discussioncontrasting

confidence: 53%

“…The combined use of jumbo forceps and NBI-magnified observation was able to achieve a low rate of local recurrence (mean 2.15 %, 95 %CI 1.4 % -3.2 %) in this study. There is a possibility that the local recurrence rates may exceed the acceptable limit of 5 % (as permitted by the American Society for Gastrointestinal Endoscopy guidelines) if CFP is performed without jumbo forceps and NBI-magnified observation [17,20]. We, therefore, recommend that jumbo forceps and NBI-magnified observation of the resection margin are utilized in CFP for diminutive polyps.…”

Section: Totalmentioning

confidence: 99%

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Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

et al. 2019

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Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP). Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis. Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02). Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.

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Section: Discussioncontrasting

confidence: 53%

Section: Totalmentioning

confidence: 99%

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

et al. 2019

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“…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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“…[30] Lee et al reported that the rate of recurrence after CFP was 17% during a median follow-up period of 59.7 months (Interquartile range [IQR], 41.1–75.6 months) in a retrospective study, whereas it remains unknown about recurrence after CSP. [31] As such, the rate of recurrence after CSP should be evaluated in a prospective study.…”

Section: Discussionmentioning

confidence: 99%

Analysis of predictive factors for R0 resection and immediate bleeding of cold snare polypectomy in colonoscopy

et al. 2019

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Background Factors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP. Methods We retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists’ experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses. Results In total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018). Conclusions A higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.

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Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps

Abstract: Although recurrence may develop after standard CFP of diminutive polyps, recurrence as advanced adenoma is rare. Large polyp size, right colon polyp, and endoscopist are risk factors for recurrence after standard CFP.

Cited by 12 publications

References 22 publications

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

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

Analysis of predictive factors for R0 resection and immediate bleeding of cold snare polypectomy in colonoscopy

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