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Steinbrück I, Ebigbo A, Kuellmer A, Schmidt A, Kouladouros K, Brand M, Koenen T, Rempel V, Wannhoff A, Faiss S, Pech O, Möschler O, Dumoulin FL, Kirstein MM, von Hahn T, Allescher HD, Gölder SK, Götz M, Hollerbach S, Lewerenz B, Meining A, Messmann H, Rösch T, Allgaier HP. Cold Versus Hot Snare Endoscopic Resection of Large Nonpedunculated Colorectal Polyps: Randomized Controlled German CHRONICLE Trial. Gastroenterology 2024; 167:764-777. [PMID: 38795735 DOI: 10.1053/j.gastro.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND & AIMS Endoscopic mucosal resection (EMR) is standard therapy for nonpedunculated colorectal polyps ≥20 mm. It has been suggested recently that polyp resection without current (cold resection) may be superior to the standard technique using cutting/coagulation current (hot resection) by reducing adverse events (AEs), but evidence from a randomized trial is missing. METHODS In this randomized controlled multicentric trial involving 19 centers, nonpedunculated colorectal polyps ≥20 mm were randomly assigned to cold or hot EMR. The primary outcome was major AE (eg, perforation or postendoscopic bleeding). Among secondary outcomes, major AE subcategories, postpolypectomy syndrome, and residual adenoma were most relevant. RESULTS Between 2021 and 2023, there were 396 polyps in 363 patients (48.2% were female) enrolled for the intention-to-treat analysis. Major AEs occurred in 1.0% of the cold group and in 7.9% of the hot group (P = .001; odds ratio [OR], 0.12; 95% CI, 0.03-0.54). Rates for perforation and postendoscopic bleeding were significantly lower in the cold group, with 0% vs 3.9% (P = .007) and 1.0% vs 4.4% (P = .040). Postpolypectomy syndrome occurred with similar frequency (3.1% vs 4.4%; P = .490). After cold resection, residual adenoma was found more frequently, with 23.7% vs 13.8% (P = .020; OR, 1.94; 95% CI, 1.12-3.38). In multivariable analysis, lesion diameter of ≥4 cm was an independent predictor both for major AEs (OR, 3.37) and residual adenoma (OR, 2.47) and high-grade dysplasia/cancer for residual adenoma (OR, 2.92). CONCLUSIONS Cold resection of large, nonpedunculated colorectal polyps appears to be considerably safer than hot EMR; however, at the cost of a higher residual adenoma rate. Further studies have to confirm to what extent polyp size and histology can determine an individualized approach. German Clinical Trials Registry (Deutsches Register Klinischer Studien), Number DRKS00025170.
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Affiliation(s)
- Ingo Steinbrück
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital, University of Freiburg, Freiburg, Germany.
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Armin Kuellmer
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Robert-Bosch-Krankenhaus, Academic Teaching Hospital, University of Tübingen, Stuttgart, Germany
| | - Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy Department, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Markus Brand
- Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Teresa Koenen
- Department of Gastroenterology, Rhein-Maas-Klinikum Würselen, Academic Teaching Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Würselen, Germany
| | - Viktor Rempel
- Department of Gastroenterology, St Anna Hospital Herne, Academic Teaching Hospital Ruhr University Bochum, Bochum, Germany
| | - Andreas Wannhoff
- Department of Gastroenterology, Regionale Kliniken Holding und Services GmbH (RKH) Klinikum Ludwigsburg, Academic Teaching Hospital, University of Heidelberg, Ludwigsburg, Germany
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Academic Teaching Hospital, University of Berlin, Berlin, Germany
| | - Oliver Pech
- Department of Gastroenterology and Endoscopy, Krankenhaus Barmherzige Brüder Regensburg, Academic Teaching Hospital, University of Regensburg and Technical University of Munich, Regensburg, Germany
| | - Oliver Möschler
- Department of Endoscopy and Ultrasound, Marienhospital Osnabrück, Academic Teaching Hospital, University of Hannover, Osnabrück, Germany
| | - Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic Teaching Hospital, University of Bonn, Bonn, Germany
| | - Martha M Kirstein
- Department of Medicine I, University Hospital Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endoscopy, Asklepios Klinik Barmbek, Academic Teaching Hospital University of Hamburg, Hamburg, Germany
| | - Hans-Dieter Allescher
- Department of Gastroenterology, Klinikum Garmisch-Patenkirchen, Academic Teaching Hospital, University Munich, Garmisch-Patenkirchen, Germany
| | - Stefan K Gölder
- Department of Internal Medicine I, Ostalb-Klinikum Aalen, Academic Teaching Hospital, University of Ulm, Aalen, Germany
| | - Martin Götz
- Department of Internal Medicine, Kliniken Böblingen, Academic Teaching Hospital, University of Tübingen, Böblingen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Academic Teaching Hospital, University of Hannover, Celle, Germany
| | - Björn Lewerenz
- Department of Gastroenterology and Hepatology, Klinikum Traunstein, Academic Teaching Hospital, University of Munich, Traunstein, Germany
| | - Alexander Meining
- Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg, Germany
| | - Hans-Peter Allgaier
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital, University of Freiburg, Freiburg, Germany
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Parodi MC, Antonelli G, Galloro G, Radaelli F, Manes G, Manno M, Camellini L, Sereni G, Caserta L, Arrigoni A, Fasoli R, Sassatelli R, Pigò F, Iovino P, Scimeca D, De Luca L, Rizkala T, Tringali A, Campari C, Capogreco A, Testoni SGG, Bertani H, Fantin A, Mitri RD, Familiari P, Labardi M, De Angelis C, Anghinoni E, Rubeca T, Cassoni P, Zorzi M, Mussetto A, Hassan C, Senore C. SIED-GISCOR recommendations for colonoscopy in screening programs: Part I - Diagnostic. Dig Liver Dis 2024; 56:1350-1357. [PMID: 38105148 DOI: 10.1016/j.dld.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The implementation of FIT programs reduces incidence and mortality from CRC in the screened subjects. The ultimate efficacy for CRC morbidity and mortality prevention in a FIT program depends on the colonoscopy in FIT+ subjects that has the task of detecting and removing these advanced lesions. Recently, there has been growing evidence on factors that influence the quality of colonoscopy specifically withing organized FIT programs, prompting to dedicated interventions in order to maximize the benefit/harm ratio of post-FIT colonoscopy. This document focuses on the diagnostic phase of colonoscopy, providing indications on how to standardise colonoscopy in FIT+ subjects, regarding timing of examination, management of antithrombotic therapy, bowel preparation, competence and sedation.
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Affiliation(s)
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Giuseppe Galloro
- Surgical Endoscopy Unit, Department of Clinical Medicine and Surgery, Federico II University, 80138 Naples, Italy
| | | | - Giampiero Manes
- Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
| | - Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | | | - Giuliana Sereni
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Caserta
- Department of Medicine - Unit of Gastroenterology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Arrigo Arrigoni
- Diagnostic and Interventional Digestive Endoscopy, FPO-IRCCS Candiolo Cancer Institute, Turin, Italy
| | - Renato Fasoli
- Department of Gastroenterology and Digestive Endoscopy, Santa Croce e Carle Hospital, Cuneo 12100, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Flavia Pigò
- Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, SA, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Luca De Luca
- Digestive Endoscopy Unit, ASST Santi Paolo E Carlo, Milano, Italy
| | - Tommy Rizkala
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | | | - Cinzia Campari
- Screening Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Capogreco
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy
| | - Helga Bertani
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL, (Modena), Modena, Carpi, Italy
| | - Alberto Fantin
- Unit of Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo, Italy
| | - Pietro Familiari
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, RM, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, RM, Italy
| | - Maurizio Labardi
- Gastroenterology and Endoscopy Department, Firenze Hospital, Firenze, Italy
| | - Claudio De Angelis
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emanuela Anghinoni
- Servizio Medicina Preventiva nelle Comunità - AUSL Mantova, via Dei Toscani 1, 46100 Mantova, Italy
| | - Tiziana Rubeca
- S.C. Laboratorio regionale prevenzione oncologica, ISPO, Firenze, Italy
| | - Paola Cassoni
- Department of Medical Science, Pathology unit, University of Turin, Turin, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Alessandro Mussetto
- Gastroenterology Unit, Azienda Unità Sanitaria Locale della Romagna, Santa Maria delle Croci Hospital, Viale Vincenzo Randi, 5, Ravenna 48121, Italy
| | - Cesare Hassan
- Humanitas Clinical and Research Center -IRCCS-, Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
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Kang SJ, Tae CH, Bang CS, Shin CM, Jeong YH, Choi M, Hwang JH, Saito Y, Chiu PWY, Rerknimitr R, Khor C, Khien VV, Choi KD, Shim KN, Song GA, Lee OY. [IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:217-232. [PMID: 38918035 DOI: 10.4166/kjg.2024.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024]
Abstract
Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.
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Affiliation(s)
- Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - Vu Van Khien
- Departments of GI Endoscopy, 108 Central Hospital, Hanoi, Vietnam
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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4
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Kimura H, Takada K, Imai K, Kishida Y, Ito S, Hotta K, Inoue H, Morita Y, Nishida A, Inatomi O, Ono H, Andoh A. Low-power pure-cut hot snare polypectomy for colorectal polyps 10-14 mm in size: a multicenter retrospective study. J Gastroenterol Hepatol 2024. [PMID: 38740465 DOI: 10.1111/jgh.16616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Hot snare excision using electrocautery is widely used for large colorectal polyps (>10 mm); however, adverse events occur due to deep thermal injury. Colorectal polyps measuring 10-14 mm rarely include invasive cancer. Therefore, less invasive therapeutic options for this size category are demanding. We have developed hot snare polypectomy with low-power pure-cut current (LPPC HSP), which is expected to contribute to less deep thermal damage and lower risk of adverse events. This study aimed to evaluate the efficacy and safety of LPPC HSP for 10-14 mm colorectal polyps, compared with conventional endoscopic mucosal resection (EMR). METHODS In this multicenter, retrospective, observational study, clinical outcomes of EMR and LPPC HSP for 10-14 mm nonpedunculated colorectal polyps between January 2021 and March 2022 were compared using propensity score matching. RESULTS We identified 203 EMR and 208 LPPC HSP cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 120 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC HSP groups (95.8% vs 97.5%, P = 0.72; 90.0% vs 91.7%, P = 0.82). The rates of delayed bleeding and perforation did not differ between the groups. CONCLUSIONS Compared with conventional EMR, LPPC HSP showed a similar resection ability without an increase in adverse events. These results suggest that LPPC HSP is a safe and effective treatment for 10-14 mm nonpedunculated colorectal polyps.
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Affiliation(s)
- Hidenori Kimura
- Division of Digestive Endoscopy, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroto Inoue
- Division of Digestive Endoscopy, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yukihiro Morita
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Atsushi Nishida
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Inatomi
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Andoh
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
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Hirose R, Yoshida T, Yoshida N, Yamauchi K, Miyazaki H, Watanabe N, Bandou R, Inoue K, Ikegaya H, Nakaya T, Itoh Y. Factors determining the resection ability of snares in cold snare polypectomy: Construction of an ex vivo model for accurately evaluating resection ability. Dig Endosc 2024; 36:573-581. [PMID: 37682639 DOI: 10.1111/den.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVES Cold snare polypectomy (CSP)-dedicated snares (DSs) may have a higher resection ability than conventional snares. However, a model that can accurately and objectively evaluate and compare the resection ability of each snare has yet to be determined, and characteristics of snare parts that increase resection ability remain unknown. Therefore, we elucidated DSs' resection ability and all characteristics of the parts required for acquiring high resection ability. METHODS An ex vivo model for evaluating resection ability was generated using human colons obtained from forensic autopsy specimens. The force required to resect a 15 mm wide human colonic mucosa (FRR) was measured using this model; if the FRR is small, the resection ability is high. Next, after measuring the stiffness of each snare part, the correlation between the stiffness and resection ability was analyzed. RESULTS The force required to resect using SnareMaster Plus, Micro-Tech Cold Snare, Captivator Cold, Exacto Cold Snare, or Captivator II was 13.6 ± 1.0, 12.5 ± 1.2, 7.4 ± 1.2, 6.5 ± 1.0, and 28.7 ± 3.7 N, respectively. All DSs had significantly lower FRR than the conventional snare (Captivator II) and had higher resection ability (P < 0.001). A negative correlation was found between FRR and sheath or wire spindle stiffness, with correlation coefficients of 0.72 (P = 0.042) or 0.94 (P < 0.001), respectively. Moreover, 1 × 7 type wire rings had significantly higher friction coefficients than 1 × 3 type wire rings (P < 0.002). CONCLUSION Sheath and wire spindle stiffness should be increased to increase resection ability; 1 × 7 type wire rings may be suitable for CSP-snare parts.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuma Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuma Yamauchi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Miyazaki
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoto Watanabe
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Risa Bandou
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takaaki Nakaya
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Akizue N, Okimoto K, Matsumura T, Matsusaka K, Inaba Y, Horio R, Takahashi S, Goto C, Kurosugi A, Sonoda M, Kaneko T, Ohta Y, Taida T, Kato J, Ikeda JI, Kato N. Utility of prophylactic clipping after colorectal cold snare polypectomy in patients on oral antithrombotic agents. Gastrointest Endosc 2024; 99:826-829.e3. [PMID: 38224820 DOI: 10.1016/j.gie.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND AIMS There is no consensus on the effectiveness of prophylactic clipping after colonic cold snare polypectomy (CSP). This study aimed to evaluate the utility of prophylactic clipping in preventing delayed bleeding (DB) after colorectal CSP in patients on antithrombotic agents. METHODS We retrospectively recruited consecutive patients on antithrombotic agents who underwent colorectal CSP in Chiba University Hospital. The DB rate was compared between patients with and without prophylactic clipping. RESULTS The study included 133 patients (422 polyps) requiring prophylactic clipping and 85 patients (282 polyps) not requiring prophylactic clipping. There were no significant differences in DB and hematochezia rates between the groups. By weighted logistic regression analysis, the odds ratio of hematochezia was 0.557 (95% confidence interval, 0.225-1.378; P = .205) in patients without clipping compared to those with clipping. CONCLUSIONS Prophylactic clipping may not be necessary to prevent DB after colorectal CSP in patients on antithrombotic agents.
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Affiliation(s)
- Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Yosuke Inaba
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan
| | - Ryosuke Horio
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satsuki Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Chihiro Goto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akane Kurosugi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Sonoda
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Taida
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Chan M, Yoon J, Telford JJ, Drury CT, Wan T. Periprocedural Anticoagulation Management of Patients Undergoing Colonoscopy with Polypectomy. TH OPEN 2024; 8:e216-e223. [PMID: 38831793 PMCID: PMC11147676 DOI: 10.1055/s-0044-1787553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction/Objective Colonoscopy with polypectomy is an integral component of colorectal cancer screening. There are limited data and consensus on periprocedural anticoagulation management, especially regarding bleeding risk with uninterrupted anticoagulation and thromboembolic risk with interruption. Our aim was to determine the incidence of bleeding and thromboembolic complications among colon screening participants undergoing colonoscopy following implementation of a novel patient care pathway for standardized periprocedural anticoagulation management. Methods We conducted a retrospective study including all participants (age 50-74) on an oral anticoagulant (e.g., vitamin K antagonists, direct oral anticoagulants) referred to the British Columbia Colon Screening Program for colonoscopy following abnormal fecal immunochemical test in a 6-month period (March-August 2022). Data relating to their specific periprocedural anticoagulant management and colonoscopy results including method of polypectomy were obtained. Primary outcomes were major bleeding and arterial or venous thromboembolic events from time of oral anticoagulant interruption until 14 days of postcolonoscopy. Secondary outcomes included nonmajor and minor bleeding, acute coronary syndrome, emergency room visit, hospital admission, and death due to any cause. Results Over the 6-month period, 162 participants completed standardized periprocedural anticoagulation management, colonoscopy ± polypectomy, and 14-day follow-up. One (0.6%) had a major bleeding event and one (0.6%) had an arterial thromboembolic event. Conclusions A novel patient care pathway for standardized periprocedural anticoagulation management with a multidisciplinary team is associated with low rates of major bleeding and thrombotic complications after colonoscopy with polypectomy.
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Affiliation(s)
- Melissa Chan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Joshua Yoon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer J. Telford
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Division of Gastroenterology, University of British Columbia, Vancouver, Canada
- British Columbia Colon Screening Program, BC Cancer, Vancouver, Canada
| | - Chipman T. Drury
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
| | - Tony Wan
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
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8
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Canakis A, Chandan S, Bapaye J, Canakis J, Twery B, Mohan BP, Ramai D, Facciorusso A, Bilal M, Adler DG. Cold Snare Polypectomy in Small (<10 mm) Pedunculated Colorectal Polyps: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:370-377. [PMID: 38289665 DOI: 10.1097/mcg.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Endoscopic removal techniques for colorectal polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). Although HSP is recommended for pedunculated polyps (PPs) larger than 10 mm, data regarding use of CSP for PPs <10 mm continues to emerge. We aimed to investigate outcomes of these techniques in small (<10 mm) pedunculated colorectal polyps. METHODS Multiple databases were searched till June 2022 to identify studies involving the removal of small PPs with CSP and HSP. Random effects model was used to calculate outcomes and 95% CI. Primary outcome was the pooled rate of successful en-bloc resection. Secondary outcomes were immediate and delayed bleeding with CSP and HSP as well as prophylactic and post resection clip placement. RESULTS Six studies including 1025 patients (1111 polyps with a mean size 4 to 8.5 mm) were analyzed. 116 and 995 polyps were removed with HSP and CSP, respectively. The overall pooled rate of successful en-bloc resection with CSP was 99.7% (CI 99.1-99.9; I2 0%). Pooled immediate and delayed bleeding after CSP was 49.8% (CI 46.8-52.91; I2 98%) and 0% (CI 0.00-0.00; I2 0%), respectively. Delayed bleeding was higher with HSP, relative risk 0.05 (CI 0.01-0.43; I2 0%), P =0.006, whereas immediate bleeding was higher with CSP, relative risk 7.89 (CI 4.36-14.29; I2 0%), P <0.00001. Pooled rates of prophylactic clip placement and post-procedure clip placement (to control immediate bleeding) were 55.3% and 47.2%, respectively. Finally, right colon polyp location significantly correlated with frequency of immediate bleeding. CONCLUSION Our analysis shows that CSP is safe and effective for resection of small PPs.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Justin Canakis
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC
| | - Benjamin Twery
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO
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9
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Ali S, Khetpal N, Fatima M, Hussain S, Ali A, Khan MA, Childs C, Hasan MK. The Safety of Cold Versus Hot Snare Polypectomy in Polyps 10-20 mm: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e58462. [PMID: 38765346 PMCID: PMC11100549 DOI: 10.7759/cureus.58462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Colonoscopy remains the primary method for preventing colorectal cancer. Traditionally, hot snare polypectomy (HSP) was the method of choice for removing polyps larger than 5 mm. Yet, for polyps smaller than 10 mm, cold snare polypectomy (CSP) has become the favored approach. Lately, the use of CSP has expanded to include the removal of sessile polyps that are between 10 and 20 mm in size. Our systematic review and meta-analysis aimed to evaluate the safety of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) for resecting polyps measuring 10-20 mm. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, and Cochrane databases up to April 2020 to find studies that directly compared CSP to HSP for polyps larger than 10 mm. Our main focus was on assessing the risk of delayed bleeding after polypectomy; a secondary focus was the incidence of any adverse events that required medical intervention post procedure. Our search yielded three comparative studies, two observational studies, and one randomized controlled trial (RCT), together encompassing 1,193 polypectomy procedures. Of these, 485 were performed using CSP and 708 with HSP. The pooled odds ratio (OR) for post-polypectomy bleeding (PPB) was 0.36 (95% confidence interval {CI}: 0.02, 7.13), with a Cochran Q test P-value of 0.11 and an I2 of 53%. For the risk of any adverse events necessitating medical care, the pooled OR was 0.15 (95% CI: 0.01, 2.29), with a Cochran Q test P-value of 0.21 and an I2 of 35%. The quality of the two observational studies was deemed moderate, and the RCT was only available in abstract form, preventing quality assessment. Our analysis suggests that there is no significant difference in the incidence of delayed post-polypectomy bleeding or other adverse events requiring medical attention between CSP and HSP for polyps measuring 10-20 mm.
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Affiliation(s)
- Saeed Ali
- Division of Gastroenterology and Hepatology, University of Illinois Chicago, Chicago, USA
| | - Neelam Khetpal
- Department of Hospital Medicine, Hartford Hospital, Hartford, USA
| | - Munazza Fatima
- Department of Anesthesiology, State University of New York (SUNY) Upstate Medical University Hospital, Syracuse, USA
| | - Sana Hussain
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Asad Ali
- Department of Gastroenterology and Hepatology, State University of New York (SUNY) Upstate Medical University Hospital, Syracuse, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Christopher Childs
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, USA
| | - Muhammad K Hasan
- Department of Gastroenterology, Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, USA
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10
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Wehbe H, Gutta A, Gromski MA. Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon. Gastrointest Endosc Clin N Am 2024; 34:363-381. [PMID: 38395489 DOI: 10.1016/j.giec.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps. Topical hemostatic powders and gels are being investigated for the prevention and management of PPB. Further studies are needed to compare these topical agents with conventional therapy.
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Affiliation(s)
- Hisham Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, 550 University Boulevard, UH 3533, Indianapolis, IN 46202, USA
| | - Aditya Gutta
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA
| | - Mark A Gromski
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 North University Boulevard, Suite 4100 Indianapolis, IN 46202, USA.
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11
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Cavassola PRP, Moura DTHD, Hirsch BS, Landim DL, Bernardo WM, Moura EGHD. HOT VERSUS COLD SNARE FOR COLORECTAL POLYPECTOMIES SIZED UP TO 10MM: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23143. [PMID: 38511795 DOI: 10.1590/s0004-2803.246102023-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. OBJECTIVE We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. METHODS A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. RESULTS Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. CONCLUSION Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.
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Affiliation(s)
- Paulo Ricardo Pavanatto Cavassola
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
| | - Diogo Turiani Hourneaux de Moura
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
| | - Bruno Salomão Hirsch
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
| | - Davi Lucena Landim
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
| | - Wanderley Marques Bernardo
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
| | - Eduardo Guimarães Hourneaux de Moura
- Faculdade de Medicina da Universidade de São Paulo Hospital das Clínicas, Departamento de Gastroenterologia, Serviço de Endoscopia Gastrointestinal, Sao Paulo, SP, Brasil
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Kang SJ, Tae CH, Bang CS, Shin CM, Jeong YH, Choi M, Hwang JH, Saito Y, Chiu PWY, Rerknimitr R, Khor C, Khien VV, Choi KD, Shim KN, Song GA, Lee OY. International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy. Clin Endosc 2024; 57:141-157. [PMID: 38556472 PMCID: PMC10984749 DOI: 10.5946/ce.2024.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 04/02/2024] Open
Abstract
Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.
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Affiliation(s)
- Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
| | - Vu Van Khien
- Departments of GI Endoscopy, 108 Central Hospital, Hanoi, Vietnam
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - The Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, CA, USA
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Division of Upper GI and Metabolic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Gastroenterology and Hepatology, Singapore General Hospital and Duke-NUS Medical School, Singapore, Singapore
- Departments of GI Endoscopy, 108 Central Hospital, Hanoi, Vietnam
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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13
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Arimoto J, Chiba H, Yamada K, Nishiguchi T, Kobayashi M, Okada N, Suto T, Niikura T, Kuwabara H, Nakaoka M, Ida T. Cold snare defect protrusion and incomplete polyp resection after forced cold snare polypectomy: a prospective observational study. Endoscopy 2024; 56:14-21. [PMID: 37769690 DOI: 10.1055/a-2183-5505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Cold snare defect protrusions (CSDPs) that occur after cold snare polypectomy (CSP) are considered indicators of incomplete polyp resection (IPR). We have sometimes experienced difficulty resecting polyps with snaring alone; in such cases, a forcible pull on the snare by the endoscopist is necessary. We call this procedure "forced CSP (FCSP)." However, no previous studies have evaluated this procedure. METHODS This was a prospective observational study. From November 2020 to June 2021, the frequency, safety, and validity of FCSP were evaluated at our hospital. We distinguished CSP with snaring alone performed by the assistant as conventional CSP, and CSP requiring a forcible pull on the snare by the endoscopist as FCSP. RESULTS Of 1315 polyps removed, 105 underwent FCSP (8%). The perforation rate was 0% in both groups. The rate of CSDP after the procedure was 96.2% (101/105) with FCSP and 6.4% (77/1210) with conventional CSP (P<0.001). The rate of IPR was 12.5% (13/104) with FCSP and 6.2% (75/1208) with conventional CSP (P=0.02). Multivariable analysis identified polyps located in the cecum (risk ratio [RR], 1.13; 95%CI 1.050-1.179; P=0.003) and polyps ≥6mm in diameter (RR, 2.37; 95%CI 2.146-2.542; P<0.001) as independent risk factors for FCSP. CONCLUSIONS FCSP was performed on 105 polyps (8%) in this study. FCSP may be associated with the occurrence of CSDP and IPR. Further studies are necessary to confirm our results.
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Affiliation(s)
- Jun Arimoto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Hideyuki Chiba
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Keiji Yamada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | - Naoya Okada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Takuma Suto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | | | - Tomonori Ida
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
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Yoshida N, Dohi O, Inagaki Y, Tomita Y, Hashimoto H, Kobayashi R, Inoue K, Hirose R, Morimoto Y, Inada Y, Murakami T, Itoh Y. Efficacy of hemostatic gel for perioperative bleeding and prevention of delayed bleeding of cold snare polypectomy under anticoagulant. JGH Open 2024; 8:e13029. [PMID: 38268964 PMCID: PMC10805485 DOI: 10.1002/jgh3.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim A hemostatic gel, PuraStat (3-D Matrix, Tokyo, Japan), is used for various gastrointestinal hemostasis. In this study, we analyzed the efficacy of PuraStat for perioperative bleeding (POB) and prevention of delayed bleeding (DB) to colorectal cold snare polypectomy (CSP) with continuous anticoagulant. Methods This was a single-center, retrospective study. Subjects were lesions of 2-9 mm under continuous anticoagulant from 2021 to 2023 and treated with PuraStat for POB. The definition of POB was bleeding which did not stop spontaneously by 1.0-1.5 min after resection and needed hemostasis. Successful hemostasis was defined as cessation of bleeding within 1.0-1.5 min after spraying PuraStat and the rate of it and risk factors of POB were analyzed. For comparison, cases receiving previous CSP without PuraStat were extracted from all cases with CSP (2018-2021), and POB and DB rate (DBR) were analyzed after propensity score matching. Results One hundred twenty-two lesions (91: direct oral anticoagulant (DOAC), 31: warfarin) with anticoagulant were analyzed and the rate of successful hemostasis with PuraStat was 92.6% (DOAC/warfarin: 93.4%/80.6%, P = 0.01). The rate of DB was 0.0%. Multivariate analysis showed that significant risk factors about unsuccessful hemostasis for POB with PuraStat were lesion size 8-9 mm (P < 0.01), warfarin (P = 0.01), and combination of antiplatelet (P = 0.01). Regarding the comparison about CSP with/without PuraStat, the clipping rate and DBR were 8.5%/94.9% (P < 0.01) and 0%/1.7% (P = 1.0). Conclusion The effects of PuraStat for POB and DB in colorectal CSP with continuous anticoagulant were acceptable.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | | | - Yuri Tomita
- Department of GastroenterologyKoseikai Takeda HospitalKyotoJapan
| | - Hikaru Hashimoto
- Department of GastroenterologyOsaka General Hospital of West Japan Railway CompanyOsakaJapan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
| | | | - Yutaka Inada
- Department of GastroenterologyKyoto First Red Cross HospitalKyotoJapan
| | - Takaaki Murakami
- Department of GastroenterologyAiseikai Yamashina HospitalKyotoJapan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of MedicineGraduate School of Medical ScienceKyotoJapan
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15
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Liang Z, Wei Y, Zhang S, Li P. The efficacy and safety of cold snare polypectomy with submucosal injection for the removal of polyps less than 20 mm in size: a systematic review and meta-analysis. J Gastroenterol Hepatol 2023; 38:1892-1899. [PMID: 37608577 DOI: 10.1111/jgh.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/25/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND AND AIM Neoplastic polyp removal is important for colorectal cancer prevention. Endoscopists have proposed cold snare endoscopic mucosal resection (CS-EMR) as a solution to solve positive cutting edges and postoperative bleeding. However, many controversies regarding its specific performance in practice have been reported. The aim of this pooled analysis was to report the efficacy and safety of CS-EMR. METHODS PubMed/Medline, Embase, Google Scholar, and the Cochrane Library searched up to January 2022 to identify studies in which CS-EMR was performed for the removal of colorectal polyps measuring less than 20 mm. The primary outcome was the complete resection rate (CRR), and the secondary outcome was the rate of adverse events. RESULTS Eleven studies were included in the final analysis, which included 861 colorectal polyps. The overall CRR with CS-EMR was 96.3% (95% CI, 93.9-98.2%). The early and delayed bleeding rates of CS-EMR were 3.1% (95% CI, 1.2-5.5%) and 1.4% (95% CI, 0.6-2.4%), respectively. There were no statistical significances between CS-EMR and cold snare polypectomy (CSP) in terms of the CRR and adverse events, as well as CS-EMR and hot snare endoscopic mucosal resection (HS-EMR). CONCLUSIONS For resecting colorectal polyps measuring ≤20 mm, CS-EMR is an effective attempt. However, compared with CSP and HS-EMR, CS-EMR did not improve the efficiency and safety of polypectomy as expected. Multicenter randomized controlled trials are needed to compare CSP with CS-EMR in the resection of <10 mm polyps and HSP with CS-EMR in the resection of ≥10 mm polyps.
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Affiliation(s)
- Zheng Liang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Yongqiu Wei
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China
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Hsu WF, Chiu HM. Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives. Dig Endosc 2023; 35:822-834. [PMID: 37381701 DOI: 10.1111/den.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
Colonoscopy is crucial in preventing colorectal cancer (CRC) and reducing associated mortality. This comprehensive review examines the importance of high-quality colonoscopy and associated quality indicators, including bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate (ADR), complete resection, specimen retrieval, complication rates, and patient satisfaction, while also discussing other ADR-related metrics. Additionally, the review draws attention to often overlooked quality aspects, such as nonpolypoid lesion detection, as well as insertion and withdrawal skills. Moreover, it explores the potential of artificial intelligence in enhancing colonoscopy quality and highlights specific considerations for organized screening programs. The review also emphasizes the implications of organized screening programs and the need for continuous quality improvement. A high-quality colonoscopy is crucial for preventing postcolonoscopy CRC- and CRC-related deaths. Health-care professionals must develop a thorough understanding of colonoscopy quality components, including technical quality, patient safety, and patient experience. By prioritizing ongoing evaluation and refinement of these quality indicators, health-care providers can contribute to improved patient outcomes and develop more effective CRC screening programs.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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17
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Pohl H. Periprocedural Management of Antithrombotics - Do Not Hold if you Can! Clin Gastroenterol Hepatol 2023; 21:3015-3016. [PMID: 36720296 DOI: 10.1016/j.cgh.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Heiko Pohl
- Department of Gastroenterology, Veterans Affairs Medical Center White River Junction, White River Junction, Vermont; Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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18
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Aelvoet AS, Karstensen JG, Bastiaansen BA, van Leerdam ME, Balaguer F, Kaminski M, Hompes R, Bossuyt PM, Ricciardiello L, Latchford A, Jover R, Daca-Alvarez M, Pellisé M, Dekker E. Cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective international cohort study. Endosc Int Open 2023; 11:E1056-E1062. [PMID: 37954110 PMCID: PMC10637860 DOI: 10.1055/a-2165-7436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims In patients with familial adenomatous polyposis (FAP), endoscopic resection of duodenal adenomas is commonly performed to prevent cancer and prevent or defer duodenal surgery. However, based on studies using different resection techniques, adverse events (AEs) of polypectomy in the duodenum can be significant. We hypothesized that cold snare polypectomy (CSP) is a safe technique for duodenal adenomas in FAP and evaluated its outcomes in our centers. Patients and methods We performed a prospective international cohort study including FAP patients who underwent CSP for one or more superficial non-ampullary duodenal adenomas of any size between 2020 and 2022. At that time, this technique was common practice in our centers for superficial duodenal adenomas. The primary outcome was the occurrence of intraprocedural and post-procedural AEs. Results In total, 133 CSPs were performed in 39 patients with FAP (1-18 per session). Median adenoma size was 10 mm (interquartile range 8-15 mm), ranging from 5 to 40 mm; 27 adenomas were ≥20 mm (20%). Of the 133 polypectomies, 109 (82%) were performed after submucosal injection. Sixty-one adenomas (46%) were resected en bloc and 72 (54%) piecemeal. Macroscopic radical resection was achieved for 129 polypectomies (97%). Deep mural injury type II occurred in three polyps (2%) with no delayed perforation after prophylactic clipping. There were no clinically significant bleeds, perforations or other post-procedural AEs. Histopathology showed low-grade dysplasia in all 133 adenomas. Conclusions CSP for (multiple) superficial non-ampullary duodenal adenomas in FAP seems feasible and safe. Long-term prospective research is needed to evaluate whether protocolized duodenal polypectomies prevent cancer and surgery.
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Affiliation(s)
- Arthur S. Aelvoet
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - John G. Karstensen
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Danish Polyposis Registry, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Barbara A.J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesc Balaguer
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Michal Kaminski
- Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Roel Hompes
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M.M. Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Luigi Ricciardiello
- Policlinico di Sant'Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrew Latchford
- Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rodrigo Jover
- Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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19
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Tokuhara M, Shimatani M, Tominaga K, Nakahira H, Ohtsu T, Kouda K, Naganuma M. Evaluation of a new method, "non-injection resection using bipolar soft coagulation mode (NIRBS)", for colonic adenomatous lesions. Clin Endosc 2023; 56:623-632. [PMID: 37524565 PMCID: PMC10565442 DOI: 10.5946/ce.2022.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/21/2022] [Accepted: 12/16/2022] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called "non-injection resection using bipolar soft coagulation mode (NIRBS)" method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method. METHODS We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer. RESULTS A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1-35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation. CONCLUSIONS NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.
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Affiliation(s)
- Mitsuo Tokuhara
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan
| | - Masaaki Shimatani
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan
| | - Kazunari Tominaga
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Hiroko Nakahira
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Osaka, Japan
| | - Takuya Ohtsu
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan
| | - Katsuyasu Kouda
- Department of Hygiene and Public Health, Kansai Medical University Hirakata Hospital, Osaka, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Osaka, Japan
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20
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Abuelazm M, Mohamed I, Jaber FS, Katamesh BE, Shaikhkhalil H, Elzeftawy MA, Mahmoud A, Afifi AM, Abdelazeem B, Othman M. Cold Versus Hot Snare Polypectomy for Colorectal Polyps: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2023; 57:760-773. [PMID: 36787428 DOI: 10.1097/mcg.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Endoscopic polypectomy is an excellent tool for colon cancer prevention. With the innovation of novel resection techniques, the best method is still being investigated. Hence, we aim to evaluate the efficacy and safety of cold snare polypectomy (CSP) versus hot snare polypectomy (HSP) for colorectal polyp resection. METHODS A systematic review and meta-analysis synthesizing evidence from randomized controlled trials retrieved from PubMed, EMBASE, WOS, SCOPUS, and CENTRAL until July 16, 2022. We pooled dichotomous outcomes using risk ratio (RR) with the corresponding CI. This review's protocol was prospectively registered in PROSPERO with ID: CRD42022347496. RESULTS We included 18 randomized controlled trials with a total of 4317 patients and 7509 polyps. Pooled RR favored HSP regarding the complete resection rate (RR: 0.96 with 95% CI: 0.95, 1, P = 0.03) and local recurrence incidence (RR: 5.74 with 95% CI: 1.27, 25.8, P = 0.02). Pooled RR favored CSP regarding the colonoscopy time (mean difference: -6.50 with 95% CI: -7.55, -5.44, P = 0.00001) and polypectomy time (mean difference: -57.36 with 95% CI: -81.74, -32.98, P = 0.00001). There was no difference regarding the incidence of immediate bleeding ( P = 0.06) and perforation ( P = 0.39); however, HSP was associated with more incidence of delayed bleeding ( P = 0.01), abdominal pain ( P = 0.007), and postresection syndrome ( P = 0.02). DISCUSSION HSP is associated with a higher complete resection and lower recurrence rates; however, HSP is also associated with a higher incidence of adverse events. Therefore, improving the complete resection rate with CSP still warrants more innovation, giving the technique safety and shorter procedure duration.
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Affiliation(s)
| | - Islam Mohamed
- Department of Medicine, University of Missouri, Kansas City, USA
| | - Fouad S Jaber
- Department of Medicine, University of Missouri, Kansas City, USA
| | | | | | | | | | - Ahmed M Afifi
- Department of Medicine, University of Texas, MD Anderson Cancer Center, Texas
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, Michigan
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan
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21
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Tanaka H, Oka S, Shiotani A, Sugimoto M, Suzuki H, Naito Y, Handa O, Hisamatsu T, Fukudo S, Fujishiro M, Motoya S, Yahagi N, Yamaguchi S, Chan FKL, Lee SY, Li B, Ang TL, Abdullah M, Tablante MC, Prachayakul V, Tanaka S. Current Status of Diagnosis and Treatment of Colorectal Cancer in Asian Countries: A Questionnaire Survey. Digestion 2023; 105:62-68. [PMID: 37497916 DOI: 10.1159/000531706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/07/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Diagnostic and therapeutic methods for colorectal cancer (CRC) have advanced; however, they may be inaccessible worldwide, and their widespread use is challenging. This questionnaire survey investigates the current status of diagnosis and treatment of early-stage CRC in Asian countries. METHODS Responses to the questionnaire were obtained from 213 doctors at different institutions in 8 countries and regions. The questionnaire consisted of 39 questions on the following four topics: noninvasive diagnosis other than endoscopy (6 questions), diagnosis by magnification and image-enhanced endoscopy (IEE) including artificial intelligence (AI) (10 questions), endoscopic submucosal dissection (ESD), proper use among other therapeutic methods (11 questions), and pathologic diagnosis and surveillance (12 questions). RESULTS Although 101 of 213 respondents were affiliated with academic hospitals, there were disparities among countries and regions in the dissemination of advanced technologies, such as IEE, AI, and ESD. The NICE classification is widely used for the diagnosis of colorectal tumors using IEE, while the JNET classification with magnification was used in countries such as Japan (65/70, 92.9%) and China (16/22, 72.7%). Of the 211 respondents, 208 (98.6%) assumed that en bloc resection should be achieved for carcinomas, and 180 of 212 (84.9%) believed that ESD was the most suitable in cases with a diameter larger than 2 cm. However, colorectal ESD is not widespread in countries such as Thailand, the Philippines, and Indonesia. CONCLUSION The promotion of advanced technologies and education should be continual to enable more people to benefit from them.
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Affiliation(s)
- Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yuji Naito
- Department of Human Immunology and Nutrition Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Handa
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Motoya
- IBD Center, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Satoru Yamaguchi
- Department of Surgery, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Francis K L Chan
- Department Medicine and Therapeutics, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Sun-Young Lee
- Department of Internal Medicine, Division of Gastroenterology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Baiwen Li
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Duke-NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Murdani Abdullah
- Division of Gastroenterology Pancreatobiliary and Digestive Endoscopy, Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Maria Carla Tablante
- Department Internal Medicine, Section of Gastroenterology and Hepatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Varayu Prachayakul
- Division of Gastroenterology, Department Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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22
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Capogreco A, Alfarone L, Massimi D, Repici A. Cold resection for colorectal polyps: where we are and where we are going? Expert Rev Gastroenterol Hepatol 2023; 17:719-730. [PMID: 37318101 DOI: 10.1080/17474124.2023.2223976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Endoscopic resection of colonic precancerous lesions has been demonstrated to significantly decrease colorectal cancer (CRC) incidence and mortality. Among resection techniques, cold snare polypectomy (CSP) has been shown as a highly feasible, effective and safe option and is widely used in clinical practice, being regarded as the first-line technique for removal of small and diminutive colorectal polyps. On the other hand, conventional hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR), namely the gold standard treatments for larger polyps, may be occasionally associated to complications due to electrocautery injury. AREAS COVERED To overcome these shortcomings of electrocautery-based resection techniques, in the last few years CSP has been increasingly assessed as a treatment option for additional indications, with a focus on nonpedunculated colorectal polyps ≥10 mm. EXPERT OPINION This review aims to present current and widened indications of CSP discussing the latest findings from the most remarkable studies, with an insight into technical issues, novelties and potential advances in the near future.
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Affiliation(s)
- Antonio Capogreco
- Department of Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Ludovico Alfarone
- Department of Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of biomedical scienses, Humanitas University, Milan, Italy
| | - Davide Massimi
- Department of Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alessandro Repici
- Department of biomedical scienses, Humanitas University, Milan, Italy
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23
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Ulrich JD, Rechberger P, Bachmann J, Herner A, V Figura G, Lahmer T, Phillip V, Mayr U, Haller B, Jesinghaus M, Schmid RM, Abdelhafez M, Schlag C. Efficacy and Safety of Cold Snare Polypectomy of Colorectal Polyps 10-15 mm with a Hybrid Snare: A Prospective Observational Pilot Study. Digestion 2023; 104:391-399. [PMID: 37331350 DOI: 10.1159/000530642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/03/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is a safe and effective procedure for small colorectal polyps ≤9 mm. There are only limited data regarding CSP of larger neoplastic lesions. This study evaluated the efficacy and safety of CSP for polyps between 10 and 15 mm in size. METHODS In this prospective single-arm observational pilot study, patients with a least one polyp 10-15 mm were included. These polyps were preferably removed by CSP using a dedicated hybrid snare. The primary outcome was the histological complete resection rate (CRR) determined by pathologically negative margins of the specimen and no neoplastic tissue obtained from biopsies of the resection site margin. Secondary outcomes were en bloc resection rate, failure of CSP, and incidence of adverse events. RESULTS A total of 61 neoplastic polyps were removed from 39 patients. Overall CRR was 80.3% (49/61). CSP was feasible in 78.7% (48/61) of polyps and the CRR in this group was 85.4% (41/48). When CSP failed (13/61; 21.3%), lesions were successfully resected by immediate HSP using the same snare with a CRR of 61.5% (8/13) in this group. One patient presented delayed hemorrhage after HSP of a polyp but successful hemostasis was achieved with two hemoclips. No other adverse events occurred. No recurrence was seen on follow-up colonoscopy in cases with incomplete resected polyps. CONCLUSION CSP seems to be efficient and safe in removing colorectal polyps up to 15 mm. A hybrid snare seems to be particularly advantageous for these polyps as it allows immediate conversion to HSP if CSP might fail in larger polyps. This trial is registered at ClinicalTrials.gov (NCT04464837).
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Affiliation(s)
- Jörg D Ulrich
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
| | - Paul Rechberger
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jeannine Bachmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Herner
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
| | - Guido V Figura
- Private Practice for Gastroenterology and Endoscopy, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Philipps-Universität Marburg, Marburg, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Schlag
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
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24
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Liu W, Gong J, Gu L. The efficacy and safety of cold snare versus hot snare polypectomy for endoscopic removal of small colorectal polyps: a systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 2023; 38:136. [PMID: 37204495 DOI: 10.1007/s00384-023-04429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE The optimal technique for removing small colorectal polyps ranging from 5 to 10 mm in size remains uncertain. In order to compare the efficacy and adverse events between cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for removing small polyps, we conducted a systematic review and meta-analysis of available randomized controlled trials. METHODS We conducted a comprehensive search of MEDLINE, EMBASE, and the Cochrane Library databases from 1998 to May 2023 to identify randomized controlled trials that evaluated the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for resecting small colorectal polyps. The primary outcome measure was the incomplete resection rate (IRR). RESULTS Seven studies that met our study criteria, with a total of 3178 included polyps, were included in our analysis. The incomplete resection rate (IRR) was found to be significantly higher in the CSP group compared to the HSP group (risk ratio [RR] 1.57 [1.17-2.11], P = 0.003). Although the CSP group had a higher local recurrence rate than the HSP group, the difference was not statistically significant (RR: 3.98 [0.66-23.84], P = 0.13). The polyp retrieval rates were not significantly different between the two groups (RR: 1.00 [0.99-1], P = 0.22). Perforation was not reported or mentioned in any of the seven studies. The overall immediate bleeding rate was significantly higher in the CSP group than the HSP group (RR: 2.26 [1.63-3.14], P < 0.001), but immediate postpolypectomy bleeding requiring additional intervention was similar between the groups (RR: 1.08 [0.54-2.17], P = 0.82). The delayed bleeding rate (RR: 0.83 [0.45-1.55], P = 0.56) and specific polypectomy time (RR: -0.46 [-1.05-0.12], P = 0.12) were also similar between the groups. CONCLUSIONS The meta-analysis shows a significantly higher IRR for CSP compared with HSP when removing small polyps.
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Affiliation(s)
- Wentao Liu
- Department of Urology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People's Republic of China
| | - Jian Gong
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People's Republic of China
| | - Li Gu
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Hunan Province, Changsha, 410011, People's Republic of China.
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25
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Hayasaka J, Yamashita S, Matsui A, Kawai Y, Ochiai Y, Okamura T, Suzuki Y, Mitsunaga Y, Nomura K, Tanaka M, Fuchinoue K, Odagiri H, Kikuchi D, Takazawa Y, Hoteya S. Safety of Cold Snare Polypectomy during Continuous Use of Antithrombotic Drugs for Delayed Post-Polypectomy Bleeding: A Pilot Study. Dig Dis 2023; 41:729-736. [PMID: 37231888 PMCID: PMC10614267 DOI: 10.1159/000531061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cold snare polypectomy is a high-risk endoscopic procedure with a low delayed post-polypectomy bleeding rate. However, it is unclear whether delayed post-polypectomy bleeding rates increase during continuous antithrombotic treatment. This study aimed to determine the safety of cold snare polypectomy during continuous antithrombotic treatment. METHODS This single-center, retrospective cohort study enrolled patients who underwent cold snare polypectomy during antithrombotic treatment between January 2015 and December 2021. Patients were divided into continuation and withdrawal groups based on whether they continued with antithrombotic drugs or not. Propensity score matching was performed using age, sex, Charlson comorbidity index, hospitalization, scheduled treatment, type of antithrombotic drugs used, multiple medications used, indication for antithrombotic drugs, and gastrointestinal endoscopist qualifications. The delayed polypectomy bleeding rates were compared between the groups. Delayed polypectomy bleeding was defined as the presence of blood in stools and requiring endoscopic treatment or a decrease in hemoglobin level by 2 g/dL or more. RESULTS The continuation and withdrawal groups included 134 and 294 patients, respectively. Delayed polypectomy bleeding was observed in 2 patients (1.5%) and 1 patient (0.3%) in the continuation and withdrawal groups, respectively (p = 0.23), before propensity score matching, with no significant difference. After propensity score matching, delayed polypectomy bleeding was observed in 1 patient (0.9%) in the continuation group but not in the withdrawal group, with no significant difference. CONCLUSION Cold snare polypectomy during continuous antithrombotic treatment did not significantly increase delayed post-polypectomy bleeding rates. Therefore, this procedure may be safe during continuous antithrombotic treatment.
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Affiliation(s)
| | | | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yusuke Kawai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Takayuki Okamura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Mitsunaga
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Hiroyuki Odagiri
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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Winston K, Maulahela H, Raharjo DE, Tjoa K, Jonlean R. A Comparative Analysis of the Efficacy and Safety of Hot Snare Polypectomy and Cold Snare Polypectomy for Removing Small Colorectal Polyps: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e38713. [PMID: 37292560 PMCID: PMC10246601 DOI: 10.7759/cureus.38713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
Both cold snare polypectomy (CSP) and hot snare polypectomy (HSP) have been shown to be effective methods for removing small colorectal polyps, but the optimal method for achieving complete resection remains unclear. To address this issue, we conducted a systematic search of relevant articles using databases such as PubMed, ProQuest, and EBSCOhost. The search criteria included randomized controlled trials that compared CSP and HSP for small colorectal polyps ≤10 mm and the articles were screened based on specific inclusion and exclusion criteria. The data were analyzed using RevMan software (version 5.4; Cochrane Collaboration, London, United Kingdom), and meta-analysis was performed with outcomes measured using pooled odds ratios (OR) and 95% confidence intervals (CI). The Mantel-Haenszel random effect model was used to calculate the OR. We selected a total of 14 randomized controlled trials involving 11601 polyps for analysis. Pooled analysis showed no statistically significant difference in the incomplete resection rate between CSP and HSP (OR: 1.22; 95% CI: 0.88-1.73, p-value: 0.27; I2: 51%), en bloc resection rate (OR: 0.66; 95%CI: 0.38-1.13; p: 0.13; I2: 60%), and polyp retrieval rate (OR: 0.97; 95%CI: 0.59-1.57; p: 0.89; I2: 17%). For safety endpoints, there is no statistically significant difference in intraprocedural bleeding rate between CSP and HSP per patient analysis (OR: 2.37, 95% CI: 0.74-7.54; p: 0.95; I2: 74%) and per polyp basis (OR: 1.84, 95% CI: 0.72-4.72; p: 0.20; I2: 85%). CSP had lower OR for the delayed bleeding outcome when compared with the HSP group per patient basis (OR: 0.42; 95% CI: 0.2-0.86; p: 0.02; I2: 25%), but not in the per polyp analysis (OR: 0.59; 95% CI: 0.12-3; p: 0.53; I2: 0%). Total polypectomy time was significantly shorter in the CSP group (mean difference: -0.81 minutes; 95% CI: -0.96, -0.66; p:<0.00001; I2: 0%). Thus, CSP is both an efficacious and safe method for removing small colorectal polyps. Therefore, it can be recommended as a suitable alternative to HSP for the removal of small colorectal polyps. However, more studies are necessary to evaluate any long-term differences between the two methods such as polyp recurrence rates.
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Affiliation(s)
- Kevin Winston
- Hospital Medicine, Bhakti Medicare Hospital, Sukabumi, IDN
| | - Hasan Maulahela
- Gastroenterology, Cipto Mangunkusumo National General Hospital, Jakarta, IDN
| | | | - Kevin Tjoa
- Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
| | - Reganedgary Jonlean
- Faculty of Medicine, Universitas Indonesia, Jakarta, IDN
- Stem Cell Transplantation Unit, Tzu Chi Hospital, Jakarta, IDN
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27
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Inoki K, Takamaru H, Furuhashi H, Kishida Y, Shimodate Y, Sumida Y, Hosotani K, Ueyama H, Furumoto Y, Hashimoto S, Takeuchi Y, Ichijima R, Yoshizawa Y, Suzuki T, Minoda Y, Mizukami K, Matsumura T, Kasai T, Yamamura T, Ohnita K, Hara K, Esaki M, Katagiri A, Ishikawa H, Gotoda T. Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study. J Gastroenterol 2023; 58:554-564. [PMID: 36935473 DOI: 10.1007/s00535-023-01980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/02/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND The clinical course and surveillance strategy for patients who undergo cold snare polypectomy (CSP) for high-grade dysplasia (HGD) or cancer is unclear. We investigated the management of colorectal HGDs and cancers following CSP. METHODS This Japanese nationwide multicenter exploratory study was retrospectively conducted on patients who had undergone CSP for colorectal HGDs or cancers and follow-up colonoscopy at least once from 2014 to 2020. We investigated the detection rate of CSP scars, local recurrence rate (LRR), risk factors for local recurrence, and follow-up strategy. This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000043670). RESULTS We included 155 patients with 156 lesions. CSP scars were identified in 22 (31.4%), 41 (54.7%), and 10 (90.9%) patients with curative, borderline, and non-curative resection, respectively. Among them, residual tumors were observed in one (4.5%), six (14.6%), and three (30.0%) cases, respectively. The total LRR was 13.7% (95% confidence interval: 6.8-23.8). R1 resection cases (either horizontal or vertical margins positive for tumors) were associated with local recurrence (p = 0.031). Salvage endoscopic and surgical resections were performed on 21 and 10 patients, respectively. Among them, the proportion of endoscopically suspected residual tumors was significantly higher (p < 0.001) in the residual tumor-positive group (100%) than in the residual tumor-negative group (28.6%). CONCLUSIONS LRR after CSP for HGDs or cancers was 13.7% based on scar-identified cases. Salvage endoscopic or surgical resection should be performed according to the curability of the lesion and endoscopic findings during colonoscopic surveillance.
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Affiliation(s)
- Kazuya Inoki
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan.
| | - Hiroyuki Takamaru
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization, Kyushu Medical Center, Clinical Research Institute, 1-8-1 Jigyouhama, Chuo-Ku, Fukuoka City, Fukuoka, 810-8563, Japan
| | - Kazuya Hosotani
- Department of Gastroenterology, Kobe City Medical Center, General Hospital, 2-1-1 Minatojima Minamicho, Chuo-Ku, Kobe City, Hyogo, 650-0047, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-Ku, Tokyo, 130-8575, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1, MinamiKogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Ryoji Ichijima
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kami-Machi, Itabashi-Ku, Tokyo, 173-8610, Japan
| | - Yashiro Yoshizawa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-Ku, Hamamatsu-Shi, Shizuoka, 430-8558, Japan
| | - Takuto Suzuki
- Department of Endoscopy, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu City, Oita, 879-5593, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Toyotaka Kasai
- Department of Gastroenterology, Fukaya Red Cross Hospital, 5-8-1, Kamishibachonishi, Fukaya City, Saitama, 366-0052, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya City, Aichi, 466-8560, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12, Takaramachi, Nagasaki City, Nagasaki, 850-0045, Japan
| | - Ken Hara
- Division of Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8561, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan
| | - Hideki Ishikawa
- Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kami-Machi, Itabashi-Ku, Tokyo, 173-8610, Japan
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Cai MY, Zhu L, Xu XY, Xu JX, Zhang DF, Zhang Z, Li QL, Qin WZ, Feng L, Xu JG, Li P, Zhou PH. Endoscopic mucosal resection of gastrointestinal polyps with a novel low-temperature plasma radio frequency generator: a non-inferiority multi-center randomized control study. Surg Endosc 2023; 37:3272-3279. [PMID: 36890416 DOI: 10.1007/s00464-023-09945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND To evaluate the efficacy and safety of novel plasma radio frequency generator and its single-use polypectomy snares for endoscopic mucosal resection (EMR) of gastrointestinal (GI) polyps. METHODS A total of 217 patients with 413 GI polyps were recruited from four centers in China. Patients were assigned to experimental or control groups using a central randomization method. The experimental group used the novel plasma radio frequency generator and its matched single-use polypectomy snares (Neowing, Shanghai), while the control group used the high-frequency electrosurgical unit (Erbe, Germany) and disposable electrosurgical snares (Olympus, Japan). The primary endpoint was the en bloc resection rate, and the non-inferiority margin was set at 10%. Secondary endpoint included operation time, coagulation success rate, intraoperative and postoperative bleeding rate, and perforation rate. RESULTS The en bloc resection rate was 97.20% (104/107) in the experimental group and 95.45% (105/110) in the control group (P = 0.496). The operation time was 29.14 ± 20.21 min in the experimental group and 30.26 ± 18.74 min in the control group (P = 0.671). The average removal time of a single polyp in the experimental group was 7.52 ± 4.45 min, which was slightly shorter than that in the control group 8.90 ± 6.67 min, with no statistical difference (P = 0.076). The intraoperative bleeding rates of the experimental group and control group were 8.41% (9/107) and 10.00% (11/110), respectively (P = 0.686). No intraoperative perforation occurred in either group. The postoperative bleeding rates of the experimental group and the control group were 1.87% (2/107) and 4.55% (5/110), respectively (P = 0.465). No postoperative perforation occurred in the experimental group (0/107), while one case of delayed perforation occurred in the control group (1/110, 0.91%). There was no statistical difference between the two groups. CONCLUSIONS Endoscopic mucosal resection of GI polyps with the novel plasma radio frequency generator is safe and effective, and non-inferior to the conventional high-frequency electrosurgical system.
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Affiliation(s)
- Ming-Yan Cai
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Liang Zhu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiao-Yue Xu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jia-Xin Xu
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Dan-Feng Zhang
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhen Zhang
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Quan-Lin Li
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wen-Zheng Qin
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Li Feng
- Department of Gastroenterology, Central Hospital of Minhang District, Shanghai, China
| | - Jian-Guang Xu
- Department of Gastroenterology, Quzhou People's Hospital, Zhejiang, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ping-Hong Zhou
- Shanghai Collaborative Innovation Center of Endoscopy, Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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29
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Ashizawa H, Hotta K, Imai K, Ito S, Kishida Y, Takada K, Okumura T, Kawata N, Yoshida M, Maeda Y, Yamamoto Y, Minamide T, Sato J, Ishiwatari H, Matsubayashi H, Ono H. Efficacy and Safety of Gel Immersion Endoscopic Mucosal Resection for Non-Pedunculated Colorectal Polyps. Life (Basel) 2023; 13:life13030711. [PMID: 36983866 PMCID: PMC10051202 DOI: 10.3390/life13030711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Underwater endoscopic mucosal resection (UEMR) has become a popular endoscopic resection method for large colorectal neoplasms. However, visualization can be poor during UEMR due to the presence of intestinal fluid. Gel immersion endoscopic mucosal resection (GIEMR), using a specially developed gel (Viscoclear®, Otsuka Pharmaceutical Factory, Tokushima, Japan), can improve the visual field. However, reports of GIEMR for colorectal polyps are limited. Herein, we evaluated the short-term outcomes of GIEMR for non-pedunculated colorectal neoplasms (NPCRN). This single-center, retrospective, and observational study includes 25 lesions in 20 patients with NPCRN who underwent GIEMR between January and October 2022. The short-term outcomes and adverse events were evaluated. The lesion locations were as follows: right colon, 18 lesions; left colon, 7 lesions; and rectum, none. The median tumor diameter was 15 (IQR, 10–18) mm. Histological classification was as follows: sessile serrated lesion, 9 cases; adenoma, 12 cases; and intramucosal adenocarcinoma, 4 cases. The overall en bloc resection rates and R0 resection rates were 80% (20/25) and 72% (18/25). For NPCRN in 10–19 mm, the en bloc resection rate was 75% (12/16), with an R0 resection rate of 69% (11/16). No post-polypectomy bleeding, perforation, or post-coagulation syndrome were observed. The findings of our study provide preliminary evidence of the efficacy and safety of GIEMR for NPCRN. Therefore, GIEMR may be a promising novel endoscopic resection method for NPCRN.
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Affiliation(s)
| | - Kinichi Hotta
- Correspondence: ; Tel.: +81-55-989-5222; Fax: +81-55-989-5783
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30
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Ishibashi F, Suzuki S, Nagai M, Mochida K, Morishita T. Colorectal cold snare polypectomy: Current standard technique and future perspectives. Dig Endosc 2023; 35:278-286. [PMID: 35962754 DOI: 10.1111/den.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023]
Abstract
It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image-enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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31
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Fatima H, Tariq T, Gilmore A, Kim HN, Tang J, Ghabril M, Abdeljawad K. Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps. J Clin Gastroenterol 2023; 57:294-299. [PMID: 35470299 DOI: 10.1097/mcg.0000000000001699] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. MATERIALS AND METHODS Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. RESULTS We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P =0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P =0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. CONCLUSIONS CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.
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Affiliation(s)
- Hala Fatima
- Division of Gastroenterology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
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Chang LC, Chang CY, Chen CY, Tseng CH, Chen PJ, Shun CT, Hsu WF, Chen YN, Chen CC, Huang TY, Tu CH, Chen MJ, Chou CK, Lee CT, Chen PY, Wu MS, Chiu HM. Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps : A Pragmatic Randomized Controlled Trial. Ann Intern Med 2023; 176:311-319. [PMID: 36802753 DOI: 10.7326/m22-2189] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Although cold snare polypectomy (CSP) is considered effective in reducing delayed postpolypectomy bleeding risk, direct evidence supporting its safety in the general population remains lacking. OBJECTIVE To clarify whether CSP would reduce delayed bleeding risk after polypectomy compared with hot snare polypectomy (HSP) in the general population. DESIGN Multicenter randomized controlled study. (ClinicalTrials.gov: NCT03373136). SETTING 6 sites in Taiwan, July 2018 through July 2020. PARTICIPANTS Participants aged 40 years or older with polyps of 4 to 10 mm. INTERVENTION CSP or HSP to remove polyps of 4 to 10 mm. MEASUREMENTS The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Severe bleeding was defined as a decrease in hemoglobin concentration of 20 g/L or more, requiring transfusion or hemostasis. Secondary outcomes included mean polypectomy time, successful tissue retrieval, en bloc resection, complete histologic resection, and emergency service visits. RESULTS A total of 4270 participants were randomly assigned (2137 to CSP and 2133 to HSP). Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (risk difference, -1.1% [95% CI, -1.7% to -0.5%]). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, -0.3% [CI, -0.6% to -0.05%]). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, -44.0 seconds [CI, -53.1 to -34.9 seconds]) was shorter in the CSP group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ. The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, -0.4% [CI, -0.8% to -0.04%]). LIMITATION An open-label, single-blind trial. CONCLUSION Compared with HSP, CSP for small colorectal polyps significantly reduces the risk for delayed postpolypectomy bleeding, including severe events. PRIMARY FUNDING SOURCE Boston Scientific Corporation.
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Affiliation(s)
- Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.C.C., C.C.C., M.J.C., M.S.W., H.M.C.)
| | - Chi-Yang Chang
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan (C.Y.Chang)
| | - Chi-Yi Chen
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan (C.Y.Chen, C.K.C., P.Y.C.)
| | - Cheng-Hao Tseng
- Department of Gastroenterology and Hepatology, E-DA Hospital, and Department of Gastroenterology and Hepatology, E-DA Cancer Hospital, Kaohsiung, Taiwan (C.H.Tseng)
| | - Peng-Jen Chen
- Division of Gastroenterology, Tri-Service General Hospital, Taipei, Taiwan (P.J.C., T.Y.H.)
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan (C.T.S.)
| | - Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, and Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan (W.F.H., Y.N.C.)
| | - Yen-Nien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, and Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan (W.F.H., Y.N.C.)
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.C.C., C.C.C., M.J.C., M.S.W., H.M.C.)
| | - Tien-Yu Huang
- Division of Gastroenterology, Tri-Service General Hospital, Taipei, Taiwan (P.J.C., T.Y.H.)
| | - Chia-Hung Tu
- Department of Internal Medicine and Health Management Center, National Taiwan University Hospital, Taipei, Taiwan (C.H.Tu)
| | - Mei-Jyh Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.C.C., C.C.C., M.J.C., M.S.W., H.M.C.)
| | - Chu-Kuang Chou
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan (C.Y.Chen, C.K.C., P.Y.C.)
| | - Ching-Tai Lee
- Department of Gastroenterology and Hepatology, E-DA Hospital, and Department of Gastroenterology and Hepatology, I-Shou University, Kaohsiung, Taiwan (C.T.L.)
| | - Po-Yueh Chen
- Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan (C.Y.Chen, C.K.C., P.Y.C.)
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.C.C., C.C.C., M.J.C., M.S.W., H.M.C.)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (L.C.C., C.C.C., M.J.C., M.S.W., H.M.C.)
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Yoshii S, Hayashi Y, Nakamura T, Nishiyama O, Nagaike K, Nakamatsu D, Yamada T, Egawa S, Ogiyama H, Yamaguchi S, Inoue T, Uema R, Kato M, Inoue T, Tsujii Y, Shinzaki S, Iijima H, Michida T, Morii E, Takehara T. Endoscopic features and clinical course of colorectal carcinoma resected by cold snare polypectomy. J Gastroenterol Hepatol 2023. [PMID: 36797208 DOI: 10.1111/jgh.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND AIM Cold snare polypectomy is commonly performed to remove small colorectal polyps. Accidental resection of carcinomas during this procedure has been reported. Herein, we aimed to clarify the clinicopathological features and clinical course of colorectal carcinomas resected by cold snare polypectomy. METHODS This multicenter retrospective cohort study was conducted at 10 Japanese healthcare centers. Of the colorectal lesions resected by cold snare polypectomy between April 2016 and March 2020, lesions pathologically diagnosed as carcinoma were reviewed. Centralized histology (based on the Vienna classification) and endoscopic reviews were performed. The study endpoints were endoscopic features and clinical outcomes of cold snare polypectomy-resected colorectal carcinomas (Vienna category ≥4.2). RESULTS We reviewed 74 of the 70 693 lesions resected by cold snare polypectomy. After a central pathological review, 68 lesions were diagnosed as carcinomas. The Japan Narrow-band imaging Expert Team (JNET) classification type 2B, lesion size ≥6 mm, and multinodular morphology were the significant endoscopic predictors of carcinoma resected by cold snare polypectomy. No adverse events related to the procedure occurred. Sixty-three lesions were diagnosed as carcinomas within the mucosal layer, and 34 were curative resections. Of the five carcinoma lesions with submucosal invasion, additional surgery revealed remnant cancer tissues in one lesion. No local or metastatic recurrence was observed during follow-up. CONCLUSIONS Although most of the carcinomas resected by cold snare polypectomy were within the mucosal layer, few lesions invading the submucosa were identified. Careful pre-procedural endoscopic evaluation, especially focusing on the JNET classification and multinodular morphology, is recommended.
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Affiliation(s)
- Shunsuke Yoshii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiko Nakamura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Takuya Yamada
- Department of Gastroenterology, Osaka Rosai Hospital, Osaka, Japan
| | - Satoshi Egawa
- Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Hideharu Ogiyama
- Department of Gastroenterology, Itami City Hospital, Itami, Hyogo, Japan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takuya Inoue
- Department of Gastroenterology, Osaka General Medical Center, Osaka, Japan
| | - Ryotaro Uema
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Minoru Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takanori Inoue
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
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34
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Arimoto J, Chiba H, Yamada K, Okada N, Kobayashi M, Kuwabara H, Nakaoka M, Ohata K. Safety and efficacy of a new cold snare technique with clipping for colorectal angioectasia. Endosc Int Open 2023; 11:E157-E161. [PMID: 36741341 PMCID: PMC9894689 DOI: 10.1055/a-1972-3510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
Colorectal angioectasia is a major cause of lower gastrointestinal bleeding. Use of antithrombotic agents is expected to increase with aging of the population, and bleeding from angioectasia is an important issue. Although the effectiveness of endoscopic mucosal resection for colorectal angioectasia has been reported, there are no reports of cold snare technique for angioectasia (CSA). From February 2018 to February 2022, the safety of CSA was evaluated at Omori Red Cross Hospital. We investigated the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding) after CSA and the incidence of rebleeding requiring repeated endoscopic treatment. During the study period, 106 angioectasias were identified during colonoscopy. We only targeted patients with bloody stools and/or anemia requiring treatment for bleeding from angioectasia. Finally, we included 11 angioectasias in this study. Rates of DPPB and rebleeding after CSA were 0 %. The rate of immediate bleeding during CSA was 27.3 % (3/11). Dilated capillaries could be observed pathologically in nine of 11 lesions (81.8 %). CSA was safe and can be a new treatment option in the future. To confirm our results and verify the long-term safety and efficacy of CSA, further studies are desirable.
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Keiji Yamada
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Mikio Kobayashi
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
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35
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in flexible sigmoidoscopy. Frontline Gastroenterol 2023; 14:181-200. [PMID: 37056324 PMCID: PMC10086722 DOI: 10.1136/flgastro-2022-102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
IntroductionJoint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS).MethodsA modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway.ResultsIn total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS.ConclusionThe UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Vathsan Ravindran
- Department of Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Ian L P Beales
- University of East Anglia, Norwich, UK
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Elizabeth Ratcliffe
- Department of Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Catherine Regan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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36
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Harada T, Hamada Y, Tanaka K, Horiki N, Nakagawa H. Invasive Colon Cancer Inadvertently Resected by Cold Snare Polypectomy. Intern Med 2023; 62:227-231. [PMID: 35676041 PMCID: PMC9908387 DOI: 10.2169/internalmedicine.9594-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 74-year-old man with anemia underwent colonoscopy, which revealed a 4-mm polyp in the ascending colon. The polyp was subsequently diagnosed as an adenomatous lesion according to the narrow-band imaging (NBI) International Colorectal Endoscopic classification/Japan NBI Expert Team classification and resected via cold snare polypectomy (CSP). However, a pathological examination revealed a well-differentiated adenocarcinoma with a positive vertical margin. We performed additional endoscopic resection at the CSP scar area, revealing residual submucosal cancer with lymphatic involvement. The patient then underwent additional surgical resection. In such cases, additional endoscopic resection might be a treatment option.
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Affiliation(s)
- Tetsuro Harada
- Department of Gastroenterology and Hepatology, Mie University Hospital, Japan
- Department of Gastroenterology, Kinan Hospital, Japan
| | - Yasuhiko Hamada
- Department of Gastroenterology and Hepatology, Mie University Hospital, Japan
| | - Kyosuke Tanaka
- Department of Gastroenterology and Hepatology, Mie University Hospital, Japan
| | - Noriyuki Horiki
- Department of Gastroenterology and Hepatology, Mie University Hospital, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Mie University Hospital, Japan
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37
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Li X, Zhu H, Li F, Li R, Xu H. Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis. Front Med (Lausanne) 2023; 10:1154411. [PMID: 37089613 PMCID: PMC10117900 DOI: 10.3389/fmed.2023.1154411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Background and study aims In recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4-10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods. Methods We searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times. Results Overall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56-1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11-0.73). In the network meta-analysis for 4-10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3-9.2 vs. OR: 2.6, 95% CI: 1.0-10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], p < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], p = 0.003). Underwater CSP ranked third for complete resection with no complications. Conclusion For <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4-10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.
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Affiliation(s)
- Xuanhan Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - He Zhu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Fudong Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ri Li
- Department of Library, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
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38
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Muething L, Quach B, Smith DE, Gao D, Smith JA, Simril RT, Tompkins A, Espinoza J, Cowan ML, Hammad H, Wani S, Patel SG. Adoption of Optimal Small (6-9 mm) Colorectal Polyp Resection Technique Over Time. Dig Dis Sci 2023; 68:240-251. [PMID: 35624328 DOI: 10.1007/s10620-022-07554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cold snare polypectomy (CSP) is the preferred resection technique for small (6-9 mm) polyps due to lower rate of incomplete resection compared to cold forceps polypectomy (CFP) and improved safety profile over hot snare polypectomy (HSP). AIMS To describe resection techniques for small (6-9 mm) polyps and determine factors associated with sub-optimal technique. METHODS This was retrospective cohort study of colonoscopies performed by gastroenterological and surgical endoscopists from 2012 to 2019 where at least one 6-9 mm polyp was removed. Patient, provider, and procedure characteristics were collected. Univariate and multivariate regression analyses were performed to determine factors associated with sub-optimal technique. RESULTS In total, 773 colonoscopies where 1,360 6-9 mm polyps removed by 21 endoscopists were included. CSP was used for 1,122 (82.5%), CFP for 61 (4.5%), and HSP for 177 (13.0%). Surgeon specialty was associated with CFP use (aOR 7.81; 95% CI 3.02-20.16). Polyp location in left colon (aOR 1.65; 95% CI 1.17-2.33) and pedunculated morphology (aOR 12.76; 95% CI 7.24-22.50) were associated with HSP. There was a significant increase in overall CSP use from 30.4% in 2012 to 96.8% in 2019. CONCLUSIONS 82.5% of all 6-9 mm polyps removed from 2012 to 2019 were removed using a cold snare with significant increase in CSP from 2012 to 2019. Differences in how optimal technique was adopted over time based on specialty highlight the need for standardized practice guidelines and quality monitoring.
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Affiliation(s)
- Larissa Muething
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Bill Quach
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Derek E Smith
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Dexiang Gao
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joshua A Smith
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert T Simril
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Amanda Tompkins
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeannine Espinoza
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Michelle L Cowan
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Hazem Hammad
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Sachin Wani
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Swati G Patel
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
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39
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Pedersen IB, Rawa-Golebiewska A, Calderwood AH, Brix LD, Grode LB, Botteri E, Bugajski M, Kaminski MF, Januszewicz W, Ødegaard H, Kleist B, Kalager M, Løberg M, Bretthauer M, Hoff G, Medhus A, Holme Ø. Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4-9 mm: a randomized controlled trial. Endoscopy 2022; 54:961-969. [PMID: 35008112 DOI: 10.1055/a-1734-7952] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic screening with polypectomy reduces the incidence of colorectal cancer (CRC). Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) in terms of complete polyp resection. METHODS We included patients ≥ 40 years of age at eight hospitals in four countries who had at least one non-pedunculated polyp of 4-9 mm detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP, with a non-inferiority margin of 5 %. Logistic regression models were fitted to identify the factors explaining incomplete resection. RESULTS 425 patients, with 601 polyps, randomized to either CSP or HSP were included in the analysis. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7 %) and 21 (7.4 %) were incompletely resected, respectively, with an adjusted risk difference of 3.2 % (95 %CI -1.4 % to 7.8 %). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated histology (odds ratio [OR] 3.96; 95 %CI 1.63 to 9.66) and hyperplastic histology (OR 2.52; 95 %CI 1.30 to 4.86) in adjusted analyses. CONCLUSION In this randomized trial, non-inferiority for CSP could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared with adenomas. CSP can be used safely for small polyps in routine colonoscopy practice.
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Affiliation(s)
- Ina B Pedersen
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.,Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
| | - Anna Rawa-Golebiewska
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Audrey H Calderwood
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Lone D Brix
- Department of Anesthesiology, Surgery and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
| | - Louise B Grode
- Department of Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Marek Bugajski
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Michal F Kaminski
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Wladyslaw Januszewicz
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | | | - Britta Kleist
- Department of Pathology, Sørlandet hospital, Kristiansand, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Medicine, Telemark Hospital Skien, Skien, Norway
| | - Asle Medhus
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.,Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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Trivedi M, Klapheke R, Youssef F, Wolfe S, Jih L, Chang MA, Fehmi SA, Krinsky ML, Kwong W, Savides T, Anand GS. Comparison of cold snare and hot snare polypectomy for the resection of sporadic nonampullary duodenal adenomas. Gastrointest Endosc 2022; 96:657-664.e2. [PMID: 35618029 DOI: 10.1016/j.gie.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonampullary duodenal adenomas can undergo malignant transformation, making endoscopic resection, often by hot snare (HSP) or cold snare polypectomy (CSP), necessary. Although CSP has been shown to be safer for removal of colon polyps, data comparing these techniques for the resection of duodenal adenomas are limited. Our aim was to compare the safety and efficacy of CSP and HSP for the removal of nonampullary duodenal adenomas. METHODS We performed a retrospective cohort study of patients referred to 2 academic medical centers with a histologically confirmed sporadic, nonampullary duodenal adenoma who underwent endoscopic snare polypectomy between January 1, 2007 and March 1, 2021. Patients with underlying polyposis syndromes were excluded. Outcomes included postprocedural adverse events and polyp recurrence. RESULTS Of 110 total patients, 69 underwent HSP and 41 underwent CSP. Intraprocedural bleeding was similar between both groups, but 7 patients in the HSP group experienced delayed adverse events versus none in the CSP group (P = .04). Fifty-four patients had complete polyp resection and subsequent surveillance endoscopies. Multivariate analysis showed polyp size to be associated with recurrence (per mm; odds ratio, 1.11; 95% confidence interval, 1.04-1.20; P < .01). Endoscopic resection technique (HSP vs CSP) was not a predictor of recurrence (P = .18). CONCLUSIONS HSP led to more delayed adverse events compared with CSP, whereas no significant differences on outcomes were noted, suggesting that CSP is equally effective and potentially safer for the removal of duodenal adenomas.
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Affiliation(s)
- Mehul Trivedi
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Robert Klapheke
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA
| | - Fady Youssef
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA
| | - Scott Wolfe
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA
| | - Lily Jih
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA; Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Michael A Chang
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA; Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Syed Abbas Fehmi
- Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Mary L Krinsky
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA; Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Wilson Kwong
- Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Thomas Savides
- Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
| | - Gobind S Anand
- Department of Medicine, Division of Gastroenterology, University of California San Diego, USA, San Diego, California, USA; Department of Medicine, Division of Gastroenterology, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
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41
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Rex DK, Anderson JC, Pohl H, Lahr RE, Judd S, Antaki F, Lilley K, Castelluccio PF, Vemulapalli KC. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022; 96:330-338. [PMID: 35288147 DOI: 10.1016/j.gie.2022.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Cold snare resection of colorectal lesions has been found to be safe and effective for an expanding set of colorectal lesions. In this study, we sought to understand the efficacy of simple cold snare resection and cold EMR versus hot snare resection and hot EMR for colorectal lesions 6 to 15 mm in size. METHODS At 3 U.S. centers, 235 patients with 286 colorectal lesions 6 to 15 mm in size were randomized to cold snaring, cold EMR, hot snaring, or hot EMR for nonpedunculated colorectal lesions 6 to 15 mm in size. The primary outcome was complete resection determined by 4 biopsy samples from the defect margin and 1 biopsy sample from the center of the resection defect. RESULTS The overall incomplete resection rate was 2.4% (95% confidence interval [CI], .8%-7.5%). All 7 incompletely removed polyps were 10 to 15 mm in size and removed by hot EMR (n = 4, 6.2%), hot snare (n = 2, 2.2%), or cold EMR (n = 1, 1.8%). Cold snaring had no incomplete resections, required less procedural time than the other methods, and was not associated with serious adverse events. CONCLUSIONS Cold snaring is a dominant resection technique for nonpedunculated colorectal lesions 6 to 15 mm in size. (Clinical trial registration number: NCT03462706.).
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachel E Lahr
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephanie Judd
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Fadi Antaki
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kirthi Lilley
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F Castelluccio
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Auriemma F, Sferrazza S, Bianchetti M, Savarese MF, Lamonaca L, Paduano D, Piazza N, Giuffrida E, Mete LS, Tucci A, Milluzzo SM, Iannelli C, Repici A, Mangiavillano B. From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s. World J Gastrointest Surg 2022; 14:632-655. [PMID: 36158280 PMCID: PMC9353749 DOI: 10.4240/wjgs.v14.i7.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/02/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.
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Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
| | - Mario Bianchetti
- Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
| | - Maria Flavia Savarese
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
| | - Lupe Sanchez Mete
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alessandra Tucci
- Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
| | | | - Chiara Iannelli
- Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
| | - Benedetto Mangiavillano
- Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
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Meng QQ, Rao M, Gao PJ. Effect of cold snare polypectomy for small colorectal polyps. World J Clin Cases 2022; 10:6446-6455. [PMID: 35979305 PMCID: PMC9294897 DOI: 10.12998/wjcc.v10.i19.6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays. Approximately 60%-80% of colorectal cancer is caused by intestinal polyps, and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer. The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically. Therefore, more attention has been paid to the development of endoscopic resection of intestinal polyps. In this study, we compared the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP).
AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.
METHODS Between January and December 2020, 301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital, and were divided into the CSP group (n = 154) and HSP group (n = 147). The operating time, incidence of bleeding and perforation, use of titanium clips, and complete resection rate were compared between the two groups.
RESULTS We included 249 patients (301 polyps). No differences in gender, age, and polyp size, location, shape and type were observed between the CSP and HSP groups, and the resection rates in these two groups were 93.4% and 94.5%, respectively, with no significant difference. The use of titanium clips was 15.6% and 95.9%, the operating time was 3.2 ± 0.5 min and 5.6 ± 0.8 min, the delayed bleeding rate was 0% and 2.0%, and delayed perforation was 0% and 0.7%, in the CSP and HSP groups, respectively.
CONCLUSION For sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrity as traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe and effective method for polypectomy.
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Affiliation(s)
- Qing-Qing Meng
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Min Rao
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Pu-Jun Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Repeat Cold Snare Polypectomy Can Be Performed for Recurrent Benign Lesions After Cold Snare Polypectomy. Dig Dis Sci 2022; 67:3192-3199. [PMID: 34731360 DOI: 10.1007/s10620-021-07292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Recurrence after cold snare polypectomy (CSP) sometimes occurs. We assessed the feasibility of repeat CSP for recurrence after CSP. METHODS We retrospectively reviewed recurrent lesions after CSP which were resected by repeat CSP from 2016 to 2021 in our institution and analyzed clinical outcomes of repeat CSP, comparing those of non-recurrent 454 lesions receiving standard CSP in 2016 and follow-up colonoscopy. We also analyzed the recurrent rate among cases receiving follow-up in both groups. Indication of repeat CSP was lesions diagnosed as benign tumors of ≤ 10 mm. RESULTS We analyzed 80 lesions receiving repeat CSP. The polyp size (mean ± standard deviation: SD) was 4.1 ± 2.3 mm (range 2-10 mm). The right-sided colon and non-polypoid morphology rates were 66.3% and 43.8%, respectively. Histopathological diagnosis was 66 adenomas, 12 sessile serrated lesions (SSLs), 1 SSL with dysplasia, and 1 high-grade dysplasia. The procedure time (min, mean ± SD) of repeat CSP was 0.9 ± 0.8. Regarding the comparison of repeat CSP/ standard CSP group, the en bloc resection and histopathological complete resection rates were 78.8%/ 98.0% (p < 0.001) and 43.8%/59.6% (p = 0.007) and the rates of perioperative hemorrhage requiring endoscopic clipping were 1.3%/ 1.0% (p = 0.646). There were no postoperative hemorrhage and perforation in both groups (p = 1.0). Among lesions receiving follow-up colonoscopy, the mean recurrence rates (number, median follow-up period: interquartile) of repeat CSP and standard CSP group were 2.0% (1/50, 12 months: 12-24) versus 0.7% (3/454, 12 months: 12-24) (p = 0.862). CONCLUSIONS Repeat CSP for benign recurrent lesions after CSP was safe and feasible.
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45
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Yen AW, Leung JW, Koo M, Leung FW. Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions. Endosc Int Open 2022; 10:E791-E800. [PMID: 35692912 PMCID: PMC9187401 DOI: 10.1055/a-1784-4523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Adverse events are uncommon with cold snaring, but cold techniques are generally reserved for lesions ≤ 9 mm out of concern for incomplete resection or inability to mechanically resect larger lesions. In a non-distended, water-filled lumen, colorectal lesions are not stretched, enabling capture and en bloc resection of large lesions. We assessed the effectiveness and safety of underwater cold snare resection (UCSR) without submucosal injection (SI) of ≥ 10 mm non-pedunculated, non-bulky (≤ 5 mm elevation) lesions with small, thin wire snares. Patients and methods Retrospective analysis of an observational cohort of lesions removed by UCSR during colonoscopy. A single endoscopist performed procedures using a small thin wire (9-mm diameter) cold or (10-mm diameter) hybrid snare. Results Fifty-three lesions (mean 15.8 mm [SD 6.9]; range 10-35 mm) were removed by UCSR from 44 patients. Compared to a historical cohort, significantly more lesions were resected en bloc by UCSR (84.9 % [45/53]; P = 0.04) compared to conventional endoscopic mucosal resection (EMR) (64.0 % [32/50]). Results were driven by high en bloc resection rates for 10- to 19-mm lesions (97.3 % [36/37]; P = 0.01). Multiple logistic regression analysis adjusted for potential confounders showed en bloc resection was significantly associated with UCSR compared to conventional EMR (OR 3.47, P = 0.027). Omission of SI and forgoing prophylactic clipping of post-resection sites did not result in adverse outcomes. Conclusions UCSR of ≥ 10 mm non-pedunculated, non-bulky colorectal lesions is feasible with high en bloc resection rates without adverse outcomes. Omission of SI and prophylactic clipping decreased resource utilization with economic benefits. UCSR deserves further evaluation in a prospective comparative study.
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Affiliation(s)
- Andrew W. Yen
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States,University of California Davis School of Medicine, Sacramento, California, United States
| | - Joseph W. Leung
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States,University of California Davis School of Medicine, Sacramento, California, United States
| | - Malcom Koo
- Graduate Institution of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Felix W. Leung
- Sepulveda Ambulatory Care Center, VAGLAHS, Division of Gastroenterology, North Hills, California, United States,David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Ket S, Tjandra D, Hewett DG, Kheir AO, Metz AJ, Moss A, Ogra R, Tam W, Raftopoulos S, Reynolds J, Secomb R, Cavalieri L, Urquhart P, Gibson PR, Brown G. Cold snare polypectomy of colorectal polyps ≤ 10 mm on clopidogrel: Australian and New Zealand randomized controlled trial. Endosc Int Open 2022; 10:E745-E752. [PMID: 35692915 PMCID: PMC9187418 DOI: 10.1055/a-1813-1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/30/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Background and study aims Optimal peri-colonoscopic management of clopidogrel remains unclear. Cold snare polypectomy is safe and effective for removing polyps ≤ 10 mm and clips can control intraprocedural bleeding. We conducted a randomized controlled trial to compare continuation of clopidogrel versus temporary replacement of clopidogrel with aspirin for routine colonoscopy using cold snare polypectomy for polyps ≤ 10 mm.
Patients and methods Between August 2016 and August 2019, consenting participants at 12 centers were randomized to continuation of clopidogrel as a single or dual antiplatelet agent, or to temporarily take aspirin alone from 7 days prior to 2 days after routine colonoscopy. Endoscopists were blinded to group allocation. Cold snare polypectomy was used to remove polyps ≤ 10 mm, with endoscopic clips applied if intraprocedural bleeding continued for > 2 minutes. Follow-up was performed on Day 30. The trial was stopped early due to delayed patient enrollment.
Results Two hundred seventy-six consecutive polyps ≤ 10 mm were removed from 107 patients. Of the patients, 61.7 % were male with a median age of 69 years (interquartile range [IQR] 63 to 76.75). Fifty-nine patients continued on clopidogrel and 48 temporarily took aspirin instead. One hundred thirty-four polyps were removed from 49 patients who continued on clopidogrel vs 142 from 43 patients temporarily took aspirin instead (P = 0.33). Intraprocedural bleeding requiring clips occurred in 11 of 49 patients who continued on clopidogrel and in two of 43 patients who temporarily took replacing with aspirin instead (P = 0.02). More post-procedural minor bleeding was seen in the aspirin arm (six of 43 vs one of 49; P = 0.03). One patient in each arm had acute coronary syndrome, which was medically managed. None of the patients had clinically significant post-procedural bleeding.
Conclusions Continuation of clopidogrel in patients undergoing cold snare polypectomy for colorectal polyps ≤ 10 mm does not appear to increase the rate of clinically significant postpolypectomy bleeding. It is associated with an increase in intraprocedural bleeding, which can be successfully treated with clips.
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Affiliation(s)
- Shara Ket
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia,Monash University, Central Clinical School, Melbourne, Victoria, Australia
| | - Douglas Tjandra
- Department of Gastroenterology, Melbourne Health, Victoria, Australia
| | - David G. Hewett
- Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Queensland
| | - Ammar O. Kheir
- Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Queensland,Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew J. Metz
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia,Department of Medicine – Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | | | - William Tam
- Royal Adelaide Hospital, South Australia, Australia,University of Adelaide, South Australia, Australia,Calvary North Adelaide Hospital, South Australia, Australia
| | - Spiro Raftopoulos
- Sir Charles Gairdner Hospital, Western Australia,Peel Health Campus, Western Australia
| | - John Reynolds
- Biostatistics Consulting Platform, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Robyn Secomb
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | | | | | - Peter R. Gibson
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia,Monash University, Central Clinical School, Melbourne, Victoria, Australia
| | - Gregor Brown
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia,Monash University, Central Clinical School, Melbourne, Victoria, Australia,Epworth Hospital, Richmond, Victoria, Australia
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Mi B, Wang H, Liu C, Wang Q, Fu X, Wang Z, Liu F, Li W. Endoscopic follow-up of mucosal defect after hot versus cold snare polypectomy in animal model. J Gastroenterol Hepatol 2022; 37:1090-1095. [PMID: 35234317 DOI: 10.1111/jgh.15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) has received increasing attention in recent years, but few studies have assessed defect repair after polypectomy. Therefore, we compared the repair of mucosal defect after CSP and hot snare polypectomy (HSP) in a rabbit model. METHODS Resection of normal colonic mucosa using both HSP and CSP were performed in 40 male New Zealand white rabbits by an experienced endoscopist. Follow-up colonoscopy was performed after 7 and 15 days by another endoscopist. We assessed mucosal defect repair, status of healing, scar formation, and intraoperative or delayed complications (including perforation and bleeding). RESULTS Eight animals died of intraoperative or delayed perforation; follow-up colonoscopy was performed in 32 animals. On follow-up colonoscopy at 7 days after operation, 78.1% cases in the CSP group showed healing of mucosal defect compared with none in the HSP group (P < 0.001); mucosal repair score in the CSP group was significantly higher than HSP group (P < 0.001). On follow-up colonoscopy at 15 days, mucosal defect after CSP had completely healed in all cases (100%) versus 96.9% after HSP (P = 0.313). Among these healed defects, scar formation was observed in 2 of 32 cases in the CSP group compared with 19 of 31 in the HSP group (P < 0.001). Intraoperative perforation rate was significantly higher in the HSP group (15% vs 2.5%; P = 0.048). CONCLUSIONS Mucosal defect repair after CSP is quicker compared with HSP and is more likely to result in scarless healing. HSP is more likely to cause perforation in the thin colon walls.
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Affiliation(s)
- Biantao Mi
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.,Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Huimin Wang
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunliang Liu
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qi Wang
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaohong Fu
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Fang Liu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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Ikeda T, Yoshizaki T, Eguchi T, Kinugasa H, Okada A. Efficacy of specimen pasting after cold snare polypectomy for pathological evaluation of horizontal margins. Endosc Int Open 2022; 10:E572-E579. [PMID: 35571463 PMCID: PMC9106410 DOI: 10.1055/a-1784-6723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Several studies have reported that pathological horizontal margin evaluation cannot be diagnosed in cold snare polypectomy (CSP) specimens. We conducted a prospective randomized controlled trial to determine the efficacy of pasting CSP specimens on paper for pathological horizontal margins. Patients and methods This was a single-center, prospective study conducted at Osaka Saiseikai Nakatsu Hospital. In this study, the indications for CSP were adenomas ≤ 10 mm. Colorectal polyps resected by CSP were randomized to the pasting and non-pasting groups after exclusion of fragmented specimens, and the extended CSP specimens pasted on paper were formalin-fixed in the pasting group. The primary endpoint was rate of unclear horizontal margins after CSP. Results A total of 216 CSP specimens were analyzed. The rate of unclear horizontal margins was significantly lower in the pasting group than in the non-pasting group (15.1 % vs 33.6 %, P = 0.002). CSP specimen pasting significantly reduced the rate of unclear horizontal margins. On multivariate analysis, non-pasting group (odds ratio [OR], 2.69; 95 % confidence interval [CI], 1.38-5.41; P = 0.003) and right colon (OR, 1.98; 95 %CI, 1.01-4.01; P = 0.047) were independent risk factors for unclear horizontal margins in CSP specimens. Conclusions Pasting the extended specimen is important for accurate pathological examination after CSP.
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Affiliation(s)
- Takuya Ikeda
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tetsuya Yoshizaki
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan,Department of Gastroenterology Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takaaki Eguchi
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroshi Kinugasa
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Akihiko Okada
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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Morita A, Horiuchi I, Tanaka N, Takada H, Graham DY, Horiuchi A. Managing bleeding risk after cold snare polypectomy in patients receiving direct-acting oral anticoagulants. Gastrointest Endosc 2022; 95:969-974. [PMID: 35065046 DOI: 10.1016/j.gie.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The best strategy to manage direct-acting oral anticoagulants (DOACs) for patients undergoing cold snare polypectomy remains unclear. This study compared the effect of continuing versus stopping DOACs only on the day of the procedure on bleeding after cold snare polypectomy. METHODS This prospective, observational, single-center cohort study enrolled consecutive patients receiving antithrombotic agents and undergoing cold snare polypectomy of colorectal polyps ≤10 mm in diameter. During period 1 (2017 and 2018) antithrombotic agents including DOACs were not discontinued (DOAC continued group). In period 2 (2019 and 2020) DOACs were withheld only on the day of the procedure (DOAC withheld group) and restarted the next day after the procedure. The primary outcome was delayed bleeding requiring endoscopic treatment occurring within 2 weeks after cold snare polypectomy. Secondary outcomes were immediate bleeding and the number of hemostatic clips used. RESULTS For the 2 groups, 204 (DOAC continued group; 34% women; mean age, 75 years) and 264 (DOAC withheld group; 36% women; mean age, 74 years) patients were enrolled. Clinical features were similar between the 2 groups. Delayed bleeding after cold snare polypectomy occurred in 4 of 47 patients (8.5%) in the DOAC continued group versus 0 of 66 (0%) in the DOAC withheld group (P < .001). Immediate postpolypectomy bleeding occurred in 12 of 47 patients (25.5%) in the DOAC continued group versus 4 of 66 (6.1%) in the DOAC withheld group (P < .008). CONCLUSIONS Cold snare polypectomy may be safely preformed if DOACs are withheld only on the day of the procedure. (Clinical trial registration number: NCT02594813.).
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Affiliation(s)
- Atsushi Morita
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan; Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ichitaro Horiuchi
- Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Tanaka
- International Relations Office, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - David Y Graham
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
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Takamaru H, Saito Y, Hammoud GM, Mizuguchi Y, Cho H, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T. Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score-matched analysis. Gastrointest Endosc 2022; 95:982-989.e6. [PMID: 34971668 DOI: 10.1016/j.gie.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP), a safe procedure for removing colon polyps, has a low prevalence of postpolypectomy bleeding (PPB). Previous studies have failed to demonstrate differences in PPB rates between CSP and hot snare polypectomy (HSP), possibly because of their small sample sizes. This study analyzed PPB rates after CSP and HSP. METHODS This was a retrospective analysis of colorectal lesions (diameter <10 mm) treated using endoscopic resection at our institution between January 2015 and December 2019. Resections were performed using CSP or HSP, depending on the endoscopist's preference. Endoscopic and histologic findings were recorded in the endoscopic database at our institution. Propensity score (PS) matching was performed to match patient age, lesion size, macroscopic features, location of the lesions, clipping after resection, and antithrombotic agent use. The CSP and HSP groups were compared to determine the adverse event (PPB) rates. RESULTS The CSP and HSP groups included 12,928 and 2408 lesions (total of 5371 patients), respectively. Univariate analysis revealed that the overall prevalence of PPB after HSP was higher than that after CSP (odds ratio [OR], 5.39; 95% confidence interval [CI], 2.50-11.60). After PS matching (2135 lesions per group), the prevalence of PPB after HSP remained higher than that after CSP (OR, 6.0; 95% CI, 1.34-26.8). CONCLUSIONS For colorectal lesions <10 mm in diameter, the risk of PPB after CSP is significantly lower than that after HSP, after PS matching. CSP for lesions <10 mm could be safely performed compared with HSP.
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Affiliation(s)
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ghassan M Hammoud
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Hourin Cho
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Screening Center, National Cancer Center Hospital, Tokyo, Japan
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