Retrieval of colorectal polyps following snare polypectomy: Experience of the multiple-suction technique in 602 cases

Complete endoscopic removal rate of detected colorectal polyps in a real world out-patient practical setting

OBJECTIVES

Colonoscopy with adenomatous polypectomy reduces the incidence and mortality of colorectal cancer. We introduced a strategy of removing all neoplastic polyps in single-session out-patient colonoscopy using cold polypectomy. We aimed to investigate the achievement of single-session complete removal rate of detected colorectal polyps in clinical practice.

MATERIALS AND METHODS

This retrospective study included colonoscopy-scheduled 40-79-year-old outpatients, with at least one colorectal neoplasm, between January 2015 and December 2016. Exclusion criteria were: colorectal neoplasms 21 mm or larger in size; pre-examination for colorectal surgery or endoscopic submucosal dissection; colonoscopy performed by health check program; ongoing antithrombotic treatment; inflammatory bowel disease; familial adenomatous polyposis. We defined 'clean colon' as the removal of all detected neoplastic polyps in a single-session colonoscopy. We evaluated clean colon rate, factors relating to clean colon failure and complications.

RESULTS

We evaluated 2527 patients (mean age 68 years; 799 women) with 8203 colorectal polyps (7675 adenomas, 423 serrated lesions, 105 Tis and T1 cancers). In 1-4 mm polyps, cold snare polypectomy (CSP; 51.8%) and cold forceps polypectomy (CFP; 45.8%) were applied. Clean colon rates were 95.1% per patient and 97.1% per lesion. The significant factors denoting clean colon failure were inadequate bowel preparation, ≥5 lesions, and the most advanced estimated histology of adenocarcinoma, on multivariate analyses. Post-polypectomy bleeding requiring endoscopic hemostasis occurred in five patients (0.2%) who had undergone endoscopic mucosal resection (EMR) or hot snare polypectomy (HSP). Perforation occurred in one patient (0.04%) with EMR.

CONCLUSIONS

The clean colon rates were satisfactory in single-session out-patient colonoscopy using cold polypectomy.

Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative

The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.

The "golden retriever" study: improving polyp retrieval rates by providing education and competitive feedback

BACKGROUND AND AIMS

Although optical diagnosis of small colorectal polyps can be achieved at expert centers, accurate prediction of histopathological outcomes has not been achieved in all practice settings. It is therefore important that resected polyps are retrieved for histology. The aims of this study were to evaluate the effect of education and competitive feedback on the overall polyp retrieval rate and to determine which polyp-related and procedure-related factors are associated with retrieval.

METHODS

We prospectively included consecutive colonoscopies performed at a single center between April 1, 2013 and April 1, 2014. Patients with inflammatory bowel disease or familial polyposis syndromes were excluded from analysis. Six months after the start of the study, all endoscopists were educated on the importance of polyp retrieval, and a competition was started by publicly providing feedback on the retrieval rate of all endoscopists and the monthly best 3 performers (or "golden retrievers") in particular. We compared overall retrieval rates in the 6 months before and after the start of the competition.

RESULTS

The overall polyp retrieval rate improved from 88% (525/594) to 93% (978/1047), comparing consecutive colonoscopies performed in the 6 months before and during the polyp retrieval competition (P < .01). The histopathological outcomes of retrieved polyps were not different before and during the competition. The retrieval rate of right-sided polyps increased from 85% to 95% during the competition (odds ratio [OR], 3.3; 95% confidence interval [CI], 2.0-5.4), whereas the left-sided retrieval rate remained 92%. On multivariable analysis, polyp size greater than 5 mm (OR, 4.1; 95% CI, 1.8-9.6) and in competition resection (OR, 1.8; 95% CI, 1.3-2.6) were significantly associated with polyp retrieval, respectively.

CONCLUSION

Providing education and competitive feedback to endoscopists will improve polyp retrieval rates, especially for clinically relevant, right-sided polyps.

Risk factors for polyp retrieval failure in colonoscopy

INTRODUCTION

Colonoscopy is able to diagnose, resect and retrieve colonic polyps. Although retrieval of resected polyps is still globally advised, it is not always successful. We aimed to define the risk factors for polyp retrieval failure in colonoscopy.

METHODS

A single-center, retrospective study assessed 3507 consecutive and non-urgent colonoscopies, performed between September 2011 and December 2012. Colonoscopies were included in our analysis if the diagnosis of at least one polyp was established, and one or more snare polypectomies were performed. Demographic and technical data were collected according to the patient's endoscopy report.

RESULTS

A total of 1109 polyps were analyzed, corresponding to 496 colonoscopies from 483 different patients. We found that 53 (4.8%) of the resected polyps were not retrieved. In a univariate analysis, the factors associated with polyp retrieval failure were: age, polyp size, resection technique, bowel preparation, location and the presence of a previous colorectal surgery (p < 0.05). In the multivariate analysis, a previous colorectal surgery, resection by cold snare, location in the right colon, inadequate bowel preparation and a polyp size up to 5 mm were independently associated with higher polyp retrieval failure (p < 0.05).

DISCUSSION

Different and well-defined factors were associated with polyp retrieval failure. Because bowel preparation was the only modifiable factor identified, a special focus should be given to this topic.