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Rex DK, Anderson JC, Butterly LF, Day LW, Dominitz JA, Kaltenbach T, Ladabaum U, Levin TR, Shaukat A, Achkar JP, Farraye FA, Kane SV, Shaheen NJ. Quality indicators for colonoscopy. Gastrointest Endosc 2024; 100:352-381. [PMID: 39177519 DOI: 10.1016/j.gie.2024.04.2905] [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: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph C Anderson
- Department of Medicine/Division of Gastroenterology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Department of Medicine/Division of Gastroenterology, White River Junction VAMC, White River Junction, Vermont, USA; University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, University of California San Francisco; Chief Medical Officer, University of California San Francisco Health System
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA; VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Tonya Kaltenbach
- Department of Medicine, University of California, San Francisco, California, USA; Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Theodore R Levin
- Kaiser Permanente Division of Research, Pleasonton, California, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York Harbor Veterans Affairs Health Care System, New York, New York, USA
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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Rex DK, Anderson JC, Butterly LF, Day LW, Dominitz JA, Kaltenbach T, Ladabaum U, Levin TR, Shaukat A, Achkar JP, Farraye FA, Kane SV, Shaheen NJ. Quality Indicators for Colonoscopy. Am J Gastroenterol 2024:00000434-990000000-01296. [PMID: 39167112 DOI: 10.14309/ajg.0000000000002972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/19/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph C Anderson
- Division of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Division of Gastroenterology, Department of Medicine, White River Junction VAMC, White River Junction, Vermont, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Lukejohn W Day
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Chief Medical Officer, University of California San Francisco Health System, San Francisco, California, USA
| | - Jason A Dominitz
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Tonya Kaltenbach
- Department of Medicine, University of California, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Theodore R Levin
- Kaiser Permanente Division of Research, Pleasonton, California, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York Harbor Veterans Affairs Health Care System, New York, New York, USA
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
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Taghiakbari M, Anderson JC, von Renteln D, Hirschmann S, Jobse B, Pohl H. Extent of normal polyp resection margin: a possible quality measure for polyp resection. Gut 2024; 73:216-218. [PMID: 38050099 DOI: 10.1136/gutjnl-2023-330727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Mahsa Taghiakbari
- Division of Gastroenterology, Montreal University Hospital Research Center (CHUM), Montreal, Québec, Canada
| | - Joseph C Anderson
- Department of Gastroenterology, VA Medical Center, White River Junction, VT, USA
- Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel von Renteln
- Division of Gastroenterology Medicine, Depertment of Medicine, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Québec, Canada
| | - Scott Hirschmann
- Department of Pathology, VA Medical Center, White River Junction, VT, USA
| | - Bruce Jobse
- Department of Research, VA Medical Center, Bedford, Massachusetts, USA
| | - Heiko Pohl
- Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, Vermont, USA
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Lv YC, Yao YH, Lei JJ, Tang T. Cold snare polypectomy compared to cold forceps polypectomy for endoscopic resection of guideline defined diminutive polyps: A systematic review and meta-analysis of randomized trials. Indian J Gastroenterol 2023; 42:757-765. [PMID: 37776439 DOI: 10.1007/s12664-023-01441-w] [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: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND International guidelines recommend cold snare polypectomy (CSP) for polyps < 10 mm in size. However, recent randomized clinical trials (RCTs) showed conflicting results for the use of cold forceps polypectomy (CFP) vs. CSP for the resection of diminutive colorectal polyps (DCPs) (≤ 5 mm), especially for polyps ≤ 3 mm. Herein we compared CFP with CSP for patients with DCPs in this meta-analysis of RCTs. METHODS We systematically searched the Cochrane Library, PubMed and EMBASE databases from inception to November 24, 2022, (Registration number INPLASY2022110135). The primary endpoint was DCP complete resection rate. The secondary endpoints were mean polypectomy time, polyp retrieval rate and complications. RESULTS Seven RCTs involving 1023 DCPs were included. The complete resection rate (91.6% vs. 94.7%) for CFP was not significantly lower for polyps ≤ 5 mm (relative risk [RR] = 1.03; 95% confidence interval [CI]: 0.98-1.07). Sub-group analysis showed that the complete resection rate (88.7% vs. 92.4%) for CFP was not significantly lower for DCPs > 3 mm (RR = 1.04; 95% CI: 0.97-1.12). Another sub-group analysis showed that the complete resection rate (97.0% vs. 96.3%) was similar for polyps ≤ 3 mm for CFP vs. CSP (RR = 1.00; 95% CI: 0.98-1.03). The mean polypectomy time was not different between CFP and CSP (95% CI: -11.86-10.18). The polyp retrieval rate (100% vs. 96.9%) was not significantly higher for CFP (RR = 1.02; 95% CI: 0.98-1.07). There were no reported complications in the included studies. The overall study quality was moderate except for the removal of polyps ≤ 5 mm (low-quality evidence). CONCLUSION CFP was comparable to CSP for the resection of polyps ≤ 3 mm; however, caution should be taken for DCPs > 3 mm because of the low complete resection rate (< 90%).
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Affiliation(s)
- Yong-Cai Lv
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning, 561200, Guizhou Province, China
| | - Yan-Hua Yao
- Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning, 561200, Guizhou Province, China
| | - Jing-Jing Lei
- Department of Geriatric Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou Province, China
| | - Tao Tang
- Department of Gastroenterology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, No. 1558 Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
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Abuelazm M, Awad AK, Mohamed I, Mahmoud A, Shaikhkhalil H, Shaheen N, Abdelwahab O, Afifi AM, Abdelazeem B, Othman MO. Cold polypectomy techniques for small and diminutive colorectal polyps: a systematic review and network meta-analysis of randomized controlled trials. Curr Med Res Opin 2023; 39:1329-1339. [PMID: 37735986 DOI: 10.1080/03007995.2023.2262374] [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: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE In the management of small and diminutive polyps, cold polypectomy is favored over electrocautery polypectomy. However, the optimal cold polypectomy technique is still controversial. Hence, this review aims to investigate the most effective cold technique for small and diminutive colorectal polyps. METHODS We conducted a systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) which were retrieved by systematically searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through 10 February 2023. R software, (R version 4.2.0) and meta-insight software were used to pool dichotomous outcomes using risk ratio (RR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022345619. RESULTS Nineteen RCTs with 3649 patients and 4800 polyps were included in our analysis. Cold techniques (cold forceps polypectomy (CFP), jumbo forceps polypectomy (JFP), dedicated cold snare polypectomy (D-CSP), conventional cold snare polypectomy (C-CSP), underwater cold snare polypectomy (U-CSP), and cold snare endoscopic mucosal resection (CS-EMR) were included in our comparative analysis. CFP was less effective in achieving complete histological resection than C-CSP (RR: 1.10 with 95% CI [1.03-1.18]), CS-EMR (RR: 1.12 with 95% CI [1.02-1.23]), D-CSP (RR: 1.17 with 95% CI [1.04-1.32]), and U-CSP (RR: 1.21 with 95% CI [1.07-1.38]). However, the rest of the comparisons showed no difference. CONCLUSION CFP is the least effective method for small and diminutive polyps' removal, and any snare polypectomy technique will achieve better results, warranting more large-scale RCTs to investigate the most effective snare polypectomy technique.
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Affiliation(s)
| | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Islam Mohamed
- Department of Medicine, University of Missouri, Kansas City, MO, USA
| | | | | | - Nour Shaheen
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ahmed M Afifi
- Department of Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Agarwal A, Aziz M, Chuang J, Kumar A, Schlachterman A, Loren D, Kowalski T, Adler D. Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials. Gastrointest Endosc 2023; 98:7-18.e4. [PMID: 36907527 DOI: 10.1016/j.gie.2023.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/07/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND AIMS The practices for resection of diminutive colon polyps vary among endoscopists, and U.S. Multi-Society Task force guidelines recommend use of cold snare polypectomy (CSP) for this purpose. In this meta-analysis, we compared CSP and cold forceps polypectomy (CFP) for resection of diminutive polyps. METHODS Several databases were reviewed to identify randomized controlled trials that compared CSP and CFP for resection of diminutive polyps. The study outcomes of interest were complete resection of all diminutive polyps, complete resection of polyps ≤3 mm in size, failure of tissue retrieval, and polypectomy time. For categorical variables, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated; for continuous variables, mean differences (MDs) with 95% CIs were calculated. Data were analyzed by using a random-effects model, and heterogeneity was assessed by using the I2 statistic. RESULTS We included 9 studies with 1037 patients. Rate of complete resection of all diminutive polyps was significantly higher in the CSP group (OR, 1.68; 95% CI, 1.09-2.58). Subgroup analysis, including jumbo or large-capacity forceps, found no significant difference in complete resection between groups (OR, 1.43; 95% CI, .80-2.56). We found no significant between-groups in the rates of complete resection of polyps ≤3 mm in size (OR, .83; 95% CI, .30-2.31). Rate of failure of tissue retrieval was significantly higher in the CSP group (OR, 10.13; 95% CI, 2.29-44.74). No significant between-group difference was noted in polypectomy time. CONCLUSIONS CFP using large-capacity or jumbo biopsy forceps is noninferior to CSP for complete resection of diminutive polyps.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Sachit Sharma
- Department of Medicine; Division of Gastroenterology
| | - Ashu Acharya
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Amit Agarwal
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA
| | | | - Anand Kumar
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander Schlachterman
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Loren
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Douglas Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.
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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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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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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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10
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Schiemer M, Schmidt A. [Current endoscopic resection techniques in the colorectum: possibilities, perspectives, limitations]. Dtsch Med Wochenschr 2023; 148:84-93. [PMID: 36690004 DOI: 10.1055/a-1832-4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the first endoscopic polypectomies have been performed, the resection of premalignant lesions during colonoscopy has become a success story in the field of gastroenterology: Incidence and mortality of colorectal cancer have been significantly reduced with the implementation of screening programs. Most polyps in the lower gastrointestinal tract are small and easy to remove. However, larger polyps, early carcinomas and subepithelial lesions can be removed with modern endoscopic resection techniques as well. Minimally invasive endoscopic resections offer an organ-preserving alternative to surgery in a growing number of patients. In this review, we discuss the advantages and limitations of traditional and novel endoscopic resection techniques, including endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full thickness resection.
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11
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Choosing the Best Resection Tool for Polyps ≤3 mm: Is Forceps an Acceptable Alternative to Cold Snare? Am J Gastroenterol 2022; 117:1244-1245. [PMID: 35926492 DOI: 10.14309/ajg.0000000000001854] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
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12
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Randomized Controlled Trial Investigating Cold Snare and Forceps Polypectomy Among Small POLYPs in Rates of Complete Resection: The TINYPOLYP Trial. Am J Gastroenterol 2022; 117:1305-1310. [PMID: 35467557 DOI: 10.14309/ajg.0000000000001799] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Optimizing complete resection during colonoscopy is important because residual neoplastic tissue may play a role in interval cancers. The US Multi-Society Task Force recommends diminutive (≤5 mm) and small (6-9 mm) polyps be removed by cold snare polypectomy (CSP). However, evidence is less clear whether CSP retains significant advantage over cold forceps polypectomy (CFP) for polyps ≤3 mm. METHODS This study is a single-center prospective noninferiority randomized clinical trial evaluating CFP and CSP for nonpedunculated polyps ≤3 mm. Patients 18 years and older undergoing colonoscopy for any indication were recruited. During each colonoscopy, polyps underwent block randomization to removal with CFP or CSP. After polypectomy, 2 biopsies were taken from the polypectomy margin. The primary noninferiority outcome was the complete resection rate, defined by absence of residual polyp in the margin biopsies. RESULTS A total of 179 patients were included. Patients had similar distribution in age, sex, race/ethnicity, as well as indication of procedure. A total of 279 polyps ≤3 mm were identified, with 138 in the CSP group and 141 in the CFP group. Mean polypectomy time was longer for CSP compared with CFP (42.3 vs 23.2 seconds, P < 0.001), although a higher proportion of polyps removed by CFP were removed in more than 1 piece compared with CSP (15.6 vs 3.6%, P < 0.001). There were positive margin biopsies in 2 cases per cohort, with a complete resection rate of 98.3% in both groups. There was no significant difference in cohorts in complete resection rates (difference in complete resection rates was 0.057%, 95% confidence interval: -4.30% to 4.53%), demonstrating noninferiority of CFP compared with CSP. DISCUSSION Use of CFP was noninferior to CSP in the complete resection of nonpedunculated polyps ≤3 mm. CSP required significantly more time to perform compared with CFP. CFP should be considered an acceptable alternative to CSP for removal of polyps ≤3 mm.
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13
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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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14
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Fudman DI, Singal AG, Cooper MG, Lee M, Murphy CC. Prevalence of Forceps Polypectomy of Nondiminutive Polyps Is Substantial But Modifiable. Clin Gastroenterol Hepatol 2022; 20:1508-1515. [PMID: 34839039 PMCID: PMC9133266 DOI: 10.1016/j.cgh.2021.11.031] [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: 07/13/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The use of forceps for removal of nondiminutive polyps is associated with incomplete resection compared with snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for nondiminutive polyps or identified strategies to improve this practice. To address this gap, we estimated the prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multicomponent intervention to reduce inappropriate forceps polypectomy. METHODS We retrospectively reviewed all colonoscopies with polypectomies performed at 2 U.S. health systems between October 1, 2017, and September 30, 2019. We used a mixed-effects logistic regression model to examine the effect of a multicomponent intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5 mm. RESULTS A total of 9968 colonoscopies with 25,534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n = 2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (odds ratio [OR], 0.34, 95% confidence interval [CI], 0.30-0.39), from 11.4% (n = 1539) to 5.3% (n = 637). Predictors of inappropriate forceps polypectomy included inadequate bowel prep (OR, 1.25; 95% CI, 1.06-1.47), polyps in the right colon (vs left: OR, 1.29; 95% CI, 1.09-1.51), and number of polyps removed (OR, 0.96; 95% CI, 0.94-0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median OR, 3.43). In a post hoc analysis, the proportion of polyps >2 mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR, 0.62; 95% CI, 0.58-0.68). CONCLUSIONS Inappropriate forceps polypectomy is common but modifiable. The proportion of nondiminutive polyps removed with forceps polypectomy should be considered as a quality measure.
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Affiliation(s)
- David I. Fudman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center,Department of Population and Data Sciences, University of Texas Southwestern Medical Center
| | - Mark G. Cooper
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center
| | - MinJae Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth)
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15
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Fatima H, Rex DK, Imperiale T. A Pilot Randomized Trial of Polypectomy Techniques for 4 to 6 mm Colonic Polyps. J Clin Gastroenterol 2022; 56:426-432. [PMID: 34115660 DOI: 10.1097/mcg.0000000000001571] [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: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND GOALS There is variation in polypectomy techniques for resection of small polyps. Aim was to compare techniques for 4 to 6 mm polyps for recurrent adenoma, efficiency, and adverse events and to establish methodological factors for definitive trial. MATERIALS AND METHODS The study was a randomized controlled trial. Outpatients with ≥1, 4 to 6 mm polyps were randomized to cold forceps (CF), cold snare (CS), and hot snare (HS). Polypectomy site was marked with SPOT to assess for recurrence at the original polypectomy site during surveillance colonoscopy. To assess feasibility of a definitive trial we measured (1) rates of patient refusal, participation, ineligibility; (2) retention; (3) recurrent neoplasia; and (4) sample size for a definitive trial. RESULTS Three hundred fifty-three patients were randomized to 1 of the 3 polypectomy techniques, of whom 260 (73.6%) completed the initial colonoscopy (mean age 57 y, 50.4% women), with 91, 87, and 82 patients randomized to CF, CS, and HS polypectomy, respectively. Mean time for polyp resection for CF, CS, and HS were 198.8, 58.5, and 96.8 seconds, respectively, with CS and HS requiring less time than CF (P<0.001). One hundred sixty-four (63.1%) completed surveillance colonoscopy. Polyp recurrences were 9 (14.5%) with CF, 5 (9.6%) with CS, and 0 (0%) with HS. Although the recurrence relative risks with CF and CS polypectomy were 1.84 and 1.65 as compared with HS, respectively, neither was statistically significant. CONCLUSIONS CS and HS polypectomy require less time than CF. HS polypectomy may have a lower risk for recurrent neoplasia. High attrition rate is a challenge in conducting randomized controlled trial with polyp recurrence as endpoint.
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Affiliation(s)
- Hala Fatima
- Department of Internal Medicine/Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN
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16
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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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17
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Bonniaud P, Jacques J, Lambin T, Gonzalez JM, Dray X, Coron E, Leblanc S, Chevaux JB, Léger-Nguyen F, Hamel B, Lienhart I, Rivory J, Ponchon T, Saurin JC, Monzy F, Legros R, Lépilliez V, Subtil F, Barret M, Pioche M. Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification. Endosc Int Open 2022; 10:E145-E153. [PMID: 35047345 PMCID: PMC8759940 DOI: 10.1055/a-1613-5328] [Citation(s) in RCA: 4] [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: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 10/26/2022] Open
Abstract
Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen's Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different ( P < 0.001): the highest sensitivities were for NICE 2 (84.2 %) and CONECCT IIC (78.9 %), and the lowest for Kudo Vi (31.6 %). Conclusions The CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma.
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Affiliation(s)
- Paul Bonniaud
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University hospital, Limoges, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gonzalez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France
| | - Xavier Dray
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Emmanuel Coron
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nantes University Hospital, Nantes, France
| | - Sarah Leblanc
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Jean-Baptiste Chevaux
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nancy University Hospital, Nancy, France
| | | | - Benjamin Hamel
- Department of Gastroenterology, North-Ouest Hospital, Villefranche-Sur-Saône, France
| | | | - Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Frédéric Monzy
- Department of Gastroenterology, Clinique Claude Bernard, Albi, France
| | - Romain Legros
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Vincent Lépilliez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Maximilien Barret
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Hôpital Cochin, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France,Inserm U1032 LabTau, Lyon, France
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18
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Okimoto K, Maruoka D, Matsumura T, Shiratori W, Nagashima A, Ishikawa T, Tokunaga M, Kaneko T, Oura H, Kanayama K, Akizue N, Ohta Y, Taida T, Saito K, Arai M, Kato J, Kato N. Long-term outcomes of cold snare polypectomy for superficial non-ampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2022; 37:75-80. [PMID: 34409657 DOI: 10.1111/jgh.15666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/11/2021] [Accepted: 08/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The effectiveness of cold snare polypectomy (CSP) for superficial non-ampullary duodenal epithelial tumors (SNADETs) regarding long-term outcomes is not fully clarified. This study aimed to investigate long-term outcomes of CSP for SNADETs. METHODS Patients diagnosed with sporadic SNADETs and treated with CSP at Chiba University Hospital between March 2015 and May 2018 were retrospectively analyzed. Long-term outcomes, short-term outcomes, and adverse events were investigated. RESULTS In total, 35 patients with 46 lesions were included. The en-bloc resection rate was 97.8%. Thirty-seven lesions (80.4%) were diagnosed as adenomatous. The R0 resection rate for adenomatous lesions was 70.3%. Follow-up investigations more than 12 months after CSP were completed for 35 adenomatous lesions (94.6%). The median observation period after CSP was 48 months. One patient whose observation period was only 3 months died from chronic heart failure with cardiac sarcoidosis 6 months after CSP. No patient died from SNADETs. The relapse-free survival rate at 12 months after CSP was 97.1%. One recurrence (2.7%) was observed 12 months after CSP. We removed the recurrence lesion with CSP and cold forceps polypectomy. No new recurrence occurred within the observation period. No perforation or post-operative bleeding occurred for CSP. CONCLUSIONS Cold snare polypectomy for diminutive and small SNADETs is a safe and useful procedure with a high en-bloc resection rate and long-term local control capability.
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Affiliation(s)
- Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Kameido Endoscopy and Gastroenterology Clinic, Tokyo, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Wataru Shiratori
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ariki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsubasa Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mamoru Tokunaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirotaka Oura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kengo Kanayama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Akizue
- 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
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, 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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Lao W, Prasoon P, Cao G, Tan LT, Dai S, Devadasar GH, Huang X. Risk factors for incomplete polyp resection during colonoscopy. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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20
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Park E, Barge W, Kramer J, Alajati B, Jakate S, Cimbaluk D, Giusto D, Ritz E, Bishehsari F, Lee S, Singh S, Losurdo J, Brown M, DeMeo M, Abraham R, Ma K, Melson J. Interobserver reliability of methods to determine complete resection of adenomas in colonoscopy. Endoscopy 2021; 53:1250-1255. [PMID: 33285582 DOI: 10.1055/a-1331-4446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Forceps margin biopsy and polypectomy specimen margins have both been used to assess for polypectomy resection adequacy. The interobserver reliability of the two methods has not been well described. METHODS The interpretability of polypectomy specimens for presence of residual neoplasia at the margin was assessed by two blinded pathologists. Next, the concordance of forceps margin biopsy interpretations between three blinded pathologists was evaluated by calculation of interobserver κ. RESULTS Rates of polypectomy specimen margin interpretability were low: 24/92 (26 %) for pathologist A, 28/92 (30.4 %) for pathologist B. Concordance of forceps margin biopsy interpretations (n = 129) between pathologists was high. Two internal pathologists showed substantial agreement in margin biopsy interpretations (κ 0.779; 95 %CL 0.543, 0.912). The concordance remained strong after biopsies were reviewed by a third, external pathologist (κ 0.829; 95 %CL 0.658, 0.924). There was complete agreement on 123/129 (95.3 %) between all three pathologists for presence of neoplasia. CONCLUSION The majority of polypectomy specimen margins were uninterpretable by pathologists for presence of residual neoplasia. Forceps margin biopsy shows strong interobserver reliability in adenomatous lesions.
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Affiliation(s)
- Erica Park
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - William Barge
- Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, Wisconsin, USA
| | - Jason Kramer
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Bana Alajati
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shriram Jakate
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - David Cimbaluk
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Deborah Giusto
- 4Path Pathology Services Laboratory, Burr Ridge, Illinois, USA
| | - Ethan Ritz
- Clinical Informatics and Biostatistics, Rush University Medical Center, Chicago, Illinois, USA
| | - Faraz Bishehsari
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Saline Lee
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shubha Singh
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - John Losurdo
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Brown
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark DeMeo
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Rana Abraham
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Karen Ma
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Melson
- Division of Digestive Diseases and Nutrition, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Yamasaki Y, Harada K, Yamamoto S, Yasutomi E, Hirai M, Ohmori M, Oka S, Inokuchi T, Kinugasa H, Sugihara Y, Takahara M, Hiraoka S, Tanaka T, Mitsuhashi T, Okada H. Evaluation of complete cold forceps polypectomy resection rate for 3- to 5-mm colorectal polyps. Dig Endosc 2021; 33:948-954. [PMID: 33211353 DOI: 10.1111/den.13895] [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: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS The propriety of cold forceps polypectomy (CFP) using jumbo biopsy forceps for diminutive polyps remains controversial. We conducted a prospective study to evaluate the complete CFP resection rate of 3-5-mm polyps using additional endoscopic mucosal resection (EMR) specimens following CFP. PATIENTS AND METHODS Patients with 3-5-mm protruded or flat elevated colorectal polyps diagnosed endoscopically as adenomas or serrated lesions were prospectively enrolled. CFP using jumbo biopsy forceps was used to remove the eligible polyps and repeated until the absence of residuals were confirmed via image-enhanced endoscopy or chromoendoscopy. After CFP, saline was injected at the defect, and the marginal specimen of the defect was resected using EMR to histologically evaluate the residue. The primary outcome was the complete CFP resection rate, which was defined as no residue at the EMR site. Other outcomes were the number of CFP bites and the complete resection rate by lesion size. RESULTS Eighty patients with 120 polyps were enrolled. The mean polyp size was 4.1 ± 0.7 mm. The overall complete resection rate was 96.7% (95% confidence interval [CI], 91.7-98.7), and the rates for 3-, 4- and 5-mm polyps were 100% (95% CI, 86.7-100), 96.0% (95% CI, 86.5-98.9) and 95.5% (95% CI, 85.1-98.8), respectively. The one-bite CFP rates were 92%, 60% and 31% for the 3-, 4- and 5-mm polyps, respectively. CONCLUSIONS The complete CFP resection rate for 3-5-mm polyps was acceptable, although the one-bite clearance rate decreased as the polyp size increased (UMIN000028841).
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shumpei Yamamoto
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Mami Hirai
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masayasu Ohmori
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shohei Oka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Kinugasa
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masahiro Takahara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
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22
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Yoon J, Joseph J, Waterhouse DJ, Borzy C, Siemens K, Diamond S, Tsikitis VL, Bohndiek SE. First experience in clinical application of hyperspectral endoscopy for evaluation of colonic polyps. JOURNAL OF BIOPHOTONICS 2021; 14:e202100078. [PMID: 34047490 DOI: 10.1002/jbio.202100078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/07/2021] [Accepted: 05/23/2021] [Indexed: 05/06/2023]
Abstract
Early detection and resection of adenomatous polyps prevents their progression to colorectal cancer (CRC), significantly improving patient outcomes. Polyps are typically identified and removed during white-light colonoscopy. Unfortunately, the rate of interval cancers that arise between CRC screening events remains high, linked to poor visualization of polyps during screening and incomplete polyp removal. Here, we sought to evaluate the potential of a hyperspectral endoscope (HySE) to enhance polyp discrimination for detection and resection. We designed, built and tested a new compact HySE in a proof-of-concept clinical study. We successfully collected spectra from three tissue types in seven patients undergoing routine colonoscopy screening. The acquired spectral data from normal tissue and polyps, both pre- and post- resection, were subjected to quantitative analysis using spectral angle mapping and machine learning, which discriminated the data by tissue type, meriting further investigation of HySE as a clinical tool.
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Affiliation(s)
- Jonghee Yoon
- Department of Physics, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - James Joseph
- Department of Physics, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- School of Science and Engineering, Fulton Building, University of Dundee, Dundee, UK
| | - Dale J Waterhouse
- Department of Physics, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Charlie Borzy
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kyla Siemens
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah Diamond
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Sarah E Bohndiek
- Department of Physics, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
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23
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Saito Y, Oka S, Kawamura T, Shimoda R, Sekiguchi M, Tamai N, Hotta K, Matsuda T, Misawa M, Tanaka S, Iriguchi Y, Nozaki R, Yamamoto H, Yoshida M, Fujimoto K, Inoue H. Colonoscopy screening and surveillance guidelines. Dig Endosc 2021; 33:486-519. [PMID: 33713493 DOI: 10.1111/den.13972] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high-level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles.
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Affiliation(s)
- Yutaka Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shiro Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryo Shimoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naoto Tamai
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kinichi Hotta
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Masashi Misawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryoichi Nozaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | | | - Haruhiro Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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24
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Ortega-Morán JF, Azpeitia Á, Sánchez-Peralta LF, Bote-Curiel L, Pagador B, Cabezón V, Saratxaga CL, Sánchez-Margallo FM. Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis. BMC Cancer 2021; 21:467. [PMID: 33902503 PMCID: PMC8077886 DOI: 10.1186/s12885-021-08190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies. Methods Semi-structured interviews and an online survey were used. Results Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation. Conclusions This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08190-z.
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Affiliation(s)
| | - Águeda Azpeitia
- Biobanco Vasco, Fundación Vasca de Investigaciones e Innovación Sanitaria (BIOEF), Ronda de Azkue, 1, 48902, Barakaldo, Spain
| | | | - Luis Bote-Curiel
- Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, Km 41.8, 10071, Cáceres, Spain
| | - Blas Pagador
- Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, Km 41.8, 10071, Cáceres, Spain
| | - Virginia Cabezón
- Biobanco Vasco, Fundación Vasca de Investigaciones e Innovación Sanitaria (BIOEF), Ronda de Azkue, 1, 48902, Barakaldo, Spain
| | - Cristina L Saratxaga
- TECNALIA, Basque Research and Technology Alliance (BRTA), Parque Tecnológico de Bizkaia, C/Geldo. Edificio 700, E-48160, Derio, Bizkaia, Spain
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25
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Kuwai T, Yamada T, Toyokawa T, Kudo T, Esaka N, Ohta H, Yamashita H, Hosoda Y, Watanabe N, Harada N. Endoscopic resection of local recurrences of diminutive polyps by cold forceps polypectomy. Scand J Gastroenterol 2021; 56:363-368. [PMID: 33444508 DOI: 10.1080/00365521.2020.1869821] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Cold forceps polypectomy (CFP) is an effective treatment for diminutive colorectal polyps. However, polyps occasionally recur, and there is no consensus on their long-term clinical management. Therefore, we investigated the short- and long-term clinical outcomes of re-CFP for recurrent diminutive colorectal polyps. MATERIALS AND METHODS This was a follow-up of a multicenter, prospective study investigating the clinical outcomes of diminutive colorectal polyps excised by CFP with narrowband imaging-enhanced endoscopy and jumbo forceps. We evaluated short-term outcomes of re-CFP and patients at 1-year follow-up post re-CFP for recurrent colorectal polyps to determine long-term recurrence rates. Additionally, complete resection rates, clinicopathological features, number of forceps bites, and rate of short-term adverse events managed by re-CFP were evaluated. RESULTS At 1-year follow-up, local recurrence was identified in 18 patients from the original study. The mean size of local recurrent polyps was 1.5 ± 0.6 mm, and all recurrent lesions were < 3 mm. Re-CFP could successfully excise locally recurrent polyps in all cases. All recurrent lesions were low-grade adenomas; no adverse events were reported. Additionally, 16 of 18 patients were evaluated endoscopically at 2-year follow-up; no recurrence was observed. CONCLUSIONS Recurrent lesions following initial CFP were small and pathologically benign, and re-CFP was an effective treatment.
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Affiliation(s)
- Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Cancer Center and Chugoku Cancer Center, Kure, Japan
| | - Takuya Yamada
- Department of Gastroenterology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Tomohiro Kudo
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Naoki Esaka
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hajime Ohta
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Haruhiro Yamashita
- Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasuo Hosoda
- Department of Gastroenterology, National Hospital Organization Saitama Hospital, Wako, Japan
| | - Noriko Watanabe
- Department of Gastroenterology, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Naohiko Harada
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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26
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Rutter MD, Jover R. Personalizing Polypectomy Techniques Based on Polyp Characteristics. Clin Gastroenterol Hepatol 2020; 18:2859-2867. [PMID: 31563558 DOI: 10.1016/j.cgh.2019.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
Polypectomy is an essential skill for all endoscopists performing lower gastrointestinal endoscopy. Different polypectomy tools and techniques have evolved and it is important that endoscopists are familiar with these so they can select the most appropriate technique for each polyp. This narrative review updates the different concepts in tailoring polypectomy technique to the characteristics of polyps. Effective polypectomy requires different components, including the following: careful evaluation of the polyp; decision making about optimal polyp management; actual polypectomy, which includes careful positioning of the endoscope and polyp; and postpolypectomy evaluation of the results (for completeness of resection and prophylaxis of complications).
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Affiliation(s)
- Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Rodrigo Jover
- Servicio de Medina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
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27
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Jung Y, Moon JR, Jeon SR, Cha JM, Yang HJ, Park S, Ahn Y, Byeon JS, Kim HG. Usefulness of narrow-band imaging for the detection of remnant sessile-serrated adenoma (SSA) tissue after endoscopic resection: the KASID multicenter study. Surg Endosc 2020; 35:5217-5224. [PMID: 32989542 DOI: 10.1007/s00464-020-08016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND A sessile-serrated adenoma (SSA) has a high risk for incomplete resection. Little is known regarding how to immediately detect remnant SSA tissue after endoscopic resection. We investigated the usefulness of narrow-band imaging (NBI) to detect remnant SSA tissue after endoscopic mucosal resection (EMR). METHODS We performed a prospective randomized study on 138 patients who had suspicious SSA on colonoscopy at five centers. After EMR on the suspected SSA determined on the endoscopic morphology, all lesions were randomized into two inspection methods, NBI and white light endoscopy (WLE), to detect remnant tissue on the resected margin. If remnant tissue was detected, an additional resection was performed. Finally, we obtained quadrant biopsies on the resection margin to evaluate the incomplete resection. The proportion of incomplete resection was calculated by combining the detection of remnant tissue and the positivity of SSA cells on the final quadrant biopsies. The primary outcome was the proportion of remnant tissue detection, and the secondary outcome was the proportion of incomplete resection of SSA. RESULTS In all, 145 lesions from 138 patients were removed. The diagnostic rate of SSA was 87.6% (127/145). After randomization, NBI inspection was performed on 69 lesions, and WLE inspection was performed on 76 lesions. The histologic diagnostic rate of SSA was 89.9% (62/69) in the NBI group and 85.5% (65/76) in the WLE group (p > 0.05). There were no significant differences in the detection of remnant tissue (12.9% (8/62) vs. 15.4% (10/65), p > 0.05), the proportion of SSA in remnant tissue (11.3% (7/62) vs. 12.3% (8/65), p > 0.05), or the proportion of incomplete resection (6.5 (4/62) vs. 10.8 (7/65), p > 0.05) between the NBI and WLE inspection groups, respectively. CONCLUSION NBI was not superior to WLE for detecting remnant SSA tissue after EMR and could not decrease the proportion of incomplete resection of SSA.
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Affiliation(s)
- Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Rock Moon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan ro, Yongsan gu, Seoul, 04401, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan ro, Yongsan gu, Seoul, 04401, Korea
| | - Jae Myung Cha
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suyeon Park
- Biostatistical Consulting Unit, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yumi Ahn
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, 59 Daesagwan ro, Yongsan gu, Seoul, 04401, Korea.
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Djinbachian R, Iratni R, Durand M, Marques P, von Renteln D. Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis. Gastroenterology 2020; 159:904-914.e12. [PMID: 32437747 DOI: 10.1053/j.gastro.2020.05.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Incomplete resection of neoplastic colorectal polyps can result in postcolonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors. METHODS We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1 to 20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes larger than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1 to 20 mm. Secondary outcomes included IRR for polyps 1 to 10 mm and 10 to 20 mm, IRR for hot and cold snare removal of polyps 1 to 10 mm and 10 to 20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1 to 5 mm. RESULTS We identified 6148 reports and used 32 studies, with a total of 9282 polyps, in our quantitative analysis. The IRR for snare removal of polyps 1 to 20 mm was 13.8% (95% confidence interval [CI] 10.3-17.3; 13 studies, 5128 polypectomies). IRRs were 15.9% for snare removal of polyps 1 to 10 mm (95% CI 9.6-22.1; 9 studies, 2531 polypectomies) and 20.8% for snare removal of polyps 10 to 20 mm (95% CI 12.9-28.8; 6 studies, 412 polypectomies). The IRR for hot snare removal of polyps 1 to 10 mm was 14.2% (95% CI 5.2-23.2) vs 17.3% for cold snare polypectomy (95% CI 14.3‒20.3). The IRR for forceps removal of polyps 1 to 5 mm was 9.9% (95% CI 7.1-13.0) vs 4.4% for snare polypectomy (95% CI 2.9-6.1). CONCLUSIONS In a systematic review and meta-analysis, we found that colorectal polyps 1 to 20 mm are frequently incompletely resected, and that risk increases for polyps 10 mm or larger. There is no difference in IRRs of cold vs hot snares for polyps 1 to 10 mm. Snare polypectomy should be used over forceps for polyps 1 to 5 mm.
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Affiliation(s)
- Roupen Djinbachian
- Division of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, Canada; Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Ryma Iratni
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada; Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Madeleine Durand
- Division of Internal Medicine, Montreal University Hospital Center (CHUM), Montreal, Canada; Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Paola Marques
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada; Bahia State University (UNEB), Salvador, Brazil
| | - Daniel von Renteln
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada; Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada.
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Kawamura T, Takeuchi Y, Yokota I, Takagaki N. Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:67-78. [PMID: 32346645 PMCID: PMC7186011 DOI: 10.23922/jarc.2019-039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
Objectives: Cold polypectomy (CP) is widely used because of its safety profile. This systematic review and meta-analysis aimed to clarify the indications for CP based on polyp size. Methods: We searched PubMed and the Cochrane Library for randomized controlled trials that compared cold snare polypectomy (CSP) and other procedures for polyps ≤10 mm. Large-scale prospective observational studies were also searched to assess delayed bleeding rates. The studies were integrated to assess the risk ratio for incomplete resection rates according to polyp size. The Cochrane risk of bias tool was used to evaluate the study bias. The certainty of cumulative evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system. Results: We found 280 articles and reviewed their eligibility. We selected and extracted 12 randomized controlled trials and 3 prospective observational studies. The risk ratio of incomplete resection of polyps ≤10 mm using CSP compared with hot snare polypectomy (HSP) was 1.36 (95% confidence interval [CI], 0.92-2.01). The risk ratio for incomplete removal using CSP compared with cold forceps polypectomy (CFP) was 0.50 (95% CI, 0.31-0.82). For polyps ≤3 mm, the risk ratio of CSP compared with CFP was 1.40 (95% CI, 0.39-4.95). Certainty of cumulative evidence was considered low. No delayed bleeding after CP was reported after the treatment of 3446 polyps. Conclusions: CSP and HSP may result in the same complete resection rates for polyps ≤10 mm. For polyps ≤3 mm, CFP and CSP may have the same resection rates (PROSPERO registration number: CRD42019122132).
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Affiliation(s)
- Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Yokota
- Department of Biostatistics, Hokkaido University, Sapporo, Japan
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30
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Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91:486-519. [PMID: 32067745 DOI: 10.1016/j.gie.2020.01.029] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs San Francisco, University California-San Francisco, San Francisco, California.
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut Health Center, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California-San Diego, San Diego, California
| | | | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
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31
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Endoscopic Removal of Colorectal Lesions: Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2020; 115:435-464. [PMID: 32058340 DOI: 10.14309/ajg.0000000000000555] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Kaltenbach T, Anderson JC, Burke CA, Dominitz JA, Gupta S, Lieberman D, Robertson DJ, Shaukat A, Syngal S, Rex DK. Endoscopic Removal of Colorectal Lesions-Recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158:1095-1129. [PMID: 32122632 DOI: 10.1053/j.gastro.2019.12.018] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs San Francisco, University California-San Francisco, San Francisco, California.
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut Health Center, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, San Diego, California; University of California-San Diego, San Diego, California
| | | | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana
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Choi HH, Kim JS. Response. Gastrointest Endosc 2020; 91:203-204. [PMID: 31865990 DOI: 10.1016/j.gie.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Hyun Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Cold resection for small colonic polyps, and larger lesions, is being rapidly and widely adopted. Driven by an impressive safety and cost profile compared with conventional polypectomy, these advantages are offset by the limitations of smaller and shallower resection, and absent thermal effects that may permit persistence of residual neoplasia. To overcome this, optimal cold snare technique requires inclusion of a margin of normal mucosa and a piecemeal resection technique for larger polyps. This article examines the fundamentals of cold snare resection and evidence for its application, theorizes on limits to its application, and identifies areas for further research.
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Affiliation(s)
- Nicholas J Tutticci
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Brisbane, Queensland 4108, Australia; Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ammar O Kheir
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Brisbane, Queensland 4108, Australia; Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE. https://twitter.com/ammarkheir
| | - David G Hewett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Cnr Kessels and Troughton Roads, Coopers Plains, Brisbane, Queensland 4108, Australia; Brisbane Colonoscopy, Brisbane, Queensland, Australia.
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Rex DK. Best Practices for Resection of Diminutive and Small Polyps in the Colorectum. Gastrointest Endosc Clin N Am 2019; 29:603-612. [PMID: 31445685 DOI: 10.1016/j.giec.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diminutive colorectal lesions are polyps and flat lesions 1 to 5 mm in size, and small are 6 to 9 mm in size. The best resection method is the cold snare. Cold forceps are acceptable for 1- to 3-mm lesions, but should not be used to piecemeal polyps. Cold snaring has few complications and is more effective than cold forceps for 4- to 5-mm polyps and as effective and more efficient than hot snaring for 6- to 9-mm polyps.
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana University Hospital, 550 North University Boulevard, Suite 4100, Indianapolis, IN 46202, USA.
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36
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Lee Krinsky M. The art of diminutive polypectomy and the tools we use: Is there a best practice? Gastrointest Endosc 2019; 90:112-115. [PMID: 31228974 DOI: 10.1016/j.gie.2019.03.009] [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: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Mary Lee Krinsky
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
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Huh CW, Kim JS, Choi HH, Maeng IS, Jun SY, Kim BW. Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: a prospective randomized controlled trial. Gastrointest Endosc 2019; 90:105-111. [PMID: 30684600 DOI: 10.1016/j.gie.2019.01.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP) and jumbo forceps polypectomy (JFP) have been shown to be effective for removing diminutive colorectal polyps (DCPs) (≤5 mm). However, no study has compared complete resection rates between CSP and JFP for DCPs. The aim of this study was to compare the efficacy and safety of JFP with CSP for the removal of DCPs. METHODS This was a prospective randomized controlled trial from 2 tertiary-care referral centers. A total of 1003 patients were screened, and 169 patients with 196 DCPs were enrolled. The main outcome was complete polyp resection rate. RESULTS Of 196 diminutive polyps, 177 (90.3%) were adenomatous polyps. The overall complete resection rate was 92.1% (163/177). The complete resection rate was not significantly different between JFP and CSP groups (92.0% vs 92.2%; P = .947). JFP achieved complete resection rates comparable with CSP for polyps >3 mm (90.3% vs 89.8%; P = .928). Polypectomy procedure time, tissue retrieval rate, and rate of postpolypectomy adverse events were not significantly different between the 2 groups. CONCLUSIONS Both JFP and CSP achieved complete resection rates of >90% for DCPs. Thus, JFP may be considered for polypectomy of DCPs. (International clinical trial registry number: KCT0002805.).
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Affiliation(s)
- Cheal Wung Huh
- Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I So Maeng
- Department of Pathology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Young Jun
- Department of Pathology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Desai S, Gupta S, Copur-Dahi N, Krinsky ML. A prospective randomized study comparing jumbo biopsy forceps to cold snare for the resection of diminutive colorectal polyps. Surg Endosc 2019; 34:1206-1213. [DOI: 10.1007/s00464-019-06874-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023]
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Parihar V, Sopheno-Falco J, Maheshwari P, O'Moran N, Graziadei V, O'Grady Walshe A, O'Dwyer O, Kumar L, Fennessy S, Breslin N, Ryan BM, McNamara D. Adherence to European Polypectomy Guidelines: Retrospective Experience from a Tertiary Irish Hospital. Gastrointest Tumors 2019; 5:82-89. [PMID: 30976579 DOI: 10.1159/000494351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/09/2018] [Indexed: 01/27/2023] Open
Abstract
Background and Study Aim The European guidelines for colorectal cancer screening state that snare resection should remove any polyps ≥5 mm. This study aimed to investigate if these new guidelines are adhered to in clinical practice. Patients and Methods This study consists of patients who underwent colonoscopies in Tallaght Hospital, Dublin (AMNCH), between 2012 and 2015. The size of the polyp, the method of removal, and the subspecialty and grade of the endoscopists were all recorded. Results 6,000 colonoscopies were reviewed and 687 (12.5%) of these patients were found to have polyps. In 655 (95%) colonoscopies, the caecum was positively identified. In all, 371 (54%) of the polyps detected were < 5 mm; resection via forceps was carried out in n405 cases (59%). Overall, 16% (n = 45) of the polyps > 5 mm underwent resection with forceps, showing that the new European guidelines are not being tightly adhered to. Conclusions This study found an 84% compliance with polypectomy resection guidelines which is an improvement on previous studies. However, endoscopist grade significantly affected compliance and may reflect overall competency, highlighting the need for specific training in snare polypectomy techniques.
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Affiliation(s)
| | | | | | - Neil O'Moran
- Department of Gastroenterology AMNCH, Dublin, Ireland
| | | | | | - Orla O'Dwyer
- Department of Gastroenterology AMNCH, Dublin, Ireland
| | | | - Sean Fennessy
- Department of Gastroenterology AMNCH, Dublin, Ireland
| | - Niall Breslin
- Department of Gastroenterology AMNCH, Dublin, Ireland
| | | | - Deirdre McNamara
- Department of Gastroenterology AMNCH, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland.,TAGG (Trinity Academic Gastroenterology Group), Dublin, Ireland
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40
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Rex DK, Dekker E. How we resect colorectal polyps <20 mm in size. Gastrointest Endosc 2019; 89:449-452. [PMID: 29909094 DOI: 10.1016/j.gie.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Evelien Dekker
- Department of Gastroenterology/Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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41
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Tranquillini CV, Bernardo WM, Brunaldi VO, Moura ETD, Marques SB, Moura EGHD. BEST POLYPECTOMY TECHNIQUE FOR SMALL AND DIMINUTIVE COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS. ARQUIVOS DE GASTROENTEROLOGIA 2019; 55:358-368. [PMID: 30785519 DOI: 10.1590/s0004-2803.201800000-79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. OBJECTIVE This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). METHODS We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. RESULTS Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. CONCLUSION Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.
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Affiliation(s)
- Caio Vinicius Tranquillini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Wanderley Marques Bernardo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Vitor Ottoboni Brunaldi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Eduardo Turiani de Moura
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
| | - Sergio Barbosa Marques
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Endoscopia Gastrointestinal, São Paulo, SP, Brasil
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42
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Chang LC, Shun CT, Hsu WF, Tu CH, Chen CC, Wu MS, Chiu HM. Risk of delayed bleeding before and after implementation of cold snare polypectomy in a screening colonoscopy setting. Endosc Int Open 2019; 7:E232-E238. [PMID: 30705958 PMCID: PMC6353650 DOI: 10.1055/a-0810-0439] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Cold snare polypectomy (CSP) is considered to be effective in reducing risk of delayed bleeding but randomized trials fail to support this owing to the small sample size. The current study aimed to compare risk of delayed bleeding before and after implementation of CSP in a screening colonoscopy setting. Patients and methods This study retrospectively analyzed a prospectively maintained screening colonoscopy database in a university hospital in Taiwan. We compared the rate of delayed bleeding before and after implementation within similar periods (18 months and 15 months) and the respective number of polypectomies (1,304 and 1,255) performed to remove small and diminutive polyps. The main outcome measurement was delayed bleeding within the two periods. Multivariate analysis was performed to adjust for major confounders. Results A total of 1,304 and 1,225 subjects received hot snare polypectomy (HSP) and CSP in two separate periods, respectively. Compared with the HSP, the CSP had a lower rate of delayed bleeding (0.1 % vs . 1.1 %, P < 0.001), severe bleeding (0 % vs. 0.7 %, P < 0.01), need for second-look colonoscopy (0 % vs. 0.8 %, P < 0.01), and emergency service visits (0.1 % vs . 1.0 %, P < 0.01). Total procedure time (12.60 ± 11.45 vs . 16.48 ± 14.27 min/person, P < 0.01) and duration of hospital stay (1.18 ± 0.50 vs . 1.53 ± 5.78 hour/person, P < 0.03) were also shorter after CSP implementation. Multivariate analysis showed that HSP was an independent risk factor for delayed bleeding after adjusting for age, gender, and number of polyps (adjusted odds ratio 14.4;95 % confidence interval = 1.88 - 110.6). Conclusion Implementation of CSP significantly reduces risk of delayed bleeding associated with removing small and diminutive polyps in screening colonoscopy.
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Affiliation(s)
- Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chia-Hong Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
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43
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O’Morain N, McNamara D. Complete polypectomy and early detection and management of residual disease to reduce the risk of interval colorectal cancers. Acta Oncol 2018; 58:S4-S9. [PMID: 30457019 DOI: 10.1080/0284186x.2018.1535715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advances in colorectal polyp detection and resection methods aim to reduce interval cancer rates. Complete polypectomy is essential to reduce the risk of early recurrence and the development of interval cancers. To achieve this, polyps must first be correctly identified and then completely excised. This article reviews current adenoma detection methods in use and the management of residual disease.
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Affiliation(s)
- Neil O’Morain
- Department of Gastroenterology Adelaide and Meath Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology Adelaide and Meath Hospital, Dublin, Ireland
- School of Medicine, Trinity Academic Gastroenterology Group, Trinity College Dublin, Ireland
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44
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Chien NH, Ni MH, Huang SH, Lee CL, Lee HC, Hu JT, Lai YC, Hung CS, Chiang CK, Shen MH, Tu TC, Chen HY, Huang TC. Cold snare polypectomy vs cold forceps biopsy in endoscopic treatment of colonic small and diminutive polyps-Effectiveness and safety in the real world. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nai-Hsuan Chien
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- Department of Gastroenterology; Sijhih Cathay General Hospital; New Taipei City Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Min-Hsiang Ni
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
| | - Shih-Hung Huang
- Department of Pathology; Cathay General Hospital; Taipei Taiwan
| | - Chia-Long Lee
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Hsin-Chung Lee
- Department of Colorectal Surgery; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Jui-Ting Hu
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Yung-Chih Lai
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
| | - Chih-Sheng Hung
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Chi-Kun Chiang
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
| | - Ming-Hung Shen
- Department of Colorectal Surgery; Cathay General Hospital; Taipei Taiwan
| | - Tien-Chien Tu
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine, College of Medicine; Taipei Medical University; Taipei Taiwan
| | - Hsin-Yu Chen
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
| | - Ting-Chun Huang
- Department of Digestive Medicine; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu-Jen Catholic University; New Taipei City Taiwan
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45
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Evelien Dekker
- Department of Gastroenterology/Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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46
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Shinozaki S, Kobayashi Y, Hayashi Y, Sakamoto H, Lefor AK, Yamamoto H. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta-analysis. Dig Endosc 2018; 30:592-599. [PMID: 29675857 DOI: 10.1111/den.13173] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Safety and effectiveness of cold snare polypectomy (CSP) compared with hot snare polypectomy (HSP) has been reported. The aim of the present study is to carry out a meta-analysis of the efficacy and safety of HSP and CSP. METHODS Randomized controlled trials were reviewed to compare HSP with CSP for resecting small colorectal polyps. Outcomes reviewed include complete resection rate, polyp retrieval, delayed bleeding, perforation and procedure time. Outcomes were documented by pooled risk ratios (RR) with 95% confidence intervals (CI) using the Mantel-Haenszel random effect model. RESULTS Eight studies were reviewed in this meta-analysis, including 1665 patients with 3195 polyps. Complete resection rate using HSP was similar to CSP (RR: 1.02, 95% CI: 0.98-1.07, P = 0.31). Polyp retrieval after HSP was similar to CSP (RR: 1.00, 95% CI: 1.00-1.01, P = 0.60). Delayed bleeding rate after HSP was higher than after CSP, although not significantly (patient basis: RR: 7.53, 95% CI: 0.94-60.24, P = 0.06; polyp basis: RR: 7.35, 95% CI: 0.91-59.33, P = 0.06). Perforation was not reported in all eight studies. Total colonoscopy time for HSP was significantly longer than CSP (mean difference 7.13 min, 95% CI: 5.32-8.94, P < 0.001). Specific polypectomy time for HSP was significantly longer than CSP (mean difference 30.92 s, 95% CI: 9.15-52.68, P = 0.005). CONCLUSION This meta-analysis shows significantly shorter procedure time using CSP compared with HSP. CSP tends toward less delayed bleeding compared with HSP. We recommend CSP as the standard treatment for resecting small benign colorectal polyps.
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Affiliation(s)
- Satoshi Shinozaki
- Shinozaki Medical Clinic, Utsunomiya, Japan
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yasutoshi Kobayashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Yoshikazu Hayashi
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hirotsugu Sakamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
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47
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Dekker E, Rex DK. Advances in CRC Prevention: Screening and Surveillance. Gastroenterology 2018; 154:1970-1984. [PMID: 29454795 DOI: 10.1053/j.gastro.2018.01.069] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022]
Abstract
Colorectal cancer (CRC) is among the most commonly diagnosed cancers and causes of death from cancer across the world. CRC can, however, be detected in asymptomatic patients at a curable stage, and several studies have shown lower mortality among patients who undergo screening compared with those who do not. Using colonoscopy in CRC screening also results in the detection of precancerous polyps that can be directly removed during the procedure, thereby reducing the incidence of cancer. In the past decade, convincing evidence has appeared that the effectiveness of colonoscopy as CRC prevention tool is associated with the quality of the procedure. This review aims to provide an up-to-date overview of recent efforts to improve colonoscopy effectiveness by enhancing detection and improving the completeness and safety of resection of colorectal lesions.
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Affiliation(s)
- Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States
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48
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Suzuki S, Gotoda T, Kusano C, Ikehara H, Sugita A, Yamauchi M, Moriyama M. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc 2018; 87:1095-1103. [PMID: 29122600 DOI: 10.1016/j.gie.2017.10.041] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Curability is associated with resection width and depth in polypectomy. We evaluated the resection width and depth achieved with hot snare polypectomy (HSP) and cold snare polypectomy (CSP) for small colorectal polyps. METHODS In this single-center, prospective, randomized controlled study, patients with rectal or rectosigmoid polyps ≤10 mm in diameter were treated with HSP or CSP. Resection width was evaluated as mucosal defect size, measured immediately postprocedure and 1 day later. Resection depth was histologically evaluated using obtained specimens. RESULTS Fifty-two patients were enrolled. Mean lesion size was 5.6 mm with HSP (n = 27) and 5.8 mm with CSP (n = 25). Mean mucosal defect diameter immediately after HSP and CSP was 5.1 mm and 7.5 mm, respectively (P < .001). The diameter 1 day after the procedure increased by 29% (95% confidence interval [CI], 17%-41%) with HSP and decreased by 25% (95% CI, 18%-32%) with CSP (P < .001). Muscularis mucosa was obtained similarly with HSP and CSP (96% [95% CI, 82%-99%] vs 92% [95% CI, 75%-98%]; P = .603). Submucosal tissue was obtained significantly more frequently with HSP than with CSP (81% [95% CI, 63%-92%] vs 24% [95% CI, 11%-43%]; P < .001). CONCLUSIONS The resection width immediately after CSP was larger than that after HSP but was significantly smaller at day 1 after resection. Although the resection depth after CSP was more superficial, muscularis mucosa was obtained in most specimens. Thus, CSP has sufficient resection width and depth to enable complete polyp resection and potentially has a superior safety profile than HSP.
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Affiliation(s)
- Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hisatomo Ikehara
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan; Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan
| | - Akihiro Sugita
- Department of Pathology, Yuri Kumiai General Hospital, Akita, Japan
| | - Misa Yamauchi
- Department of Pathology, Yuri Kumiai General Hospital, Akita, Japan
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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O’Connor SA, Brooklyn TN, Dunckley PD, Valori RM, Carr R, Foy C, Somarathna T, Adamczyk LA, Shepherd NA, Anderson JT. High complete resection rate for pre-lift and cold biopsy of diminutive colorectal polyps. Endosc Int Open 2018; 6:E173-E178. [PMID: 29399614 PMCID: PMC5794434 DOI: 10.1055/s-0043-121874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 09/08/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The majority of polyps removed at colonoscopy are diminutive (≤ 5 mm) to small (< 10 mm) and there are few guidelines for the best way for these polyps to be removed. We aimed to assess the feasibility and effectiveness of cold biopsy forceps polypectomy with pre-lift (CBPP) for polyps ≤ 7 mm. Our aims were to assess completeness of histological resection of this technique, to identify factors contributing to this and assess secondary considerations such as timing, retrieval and complication rates. PATIENTS AND METHODS We conducted a prospective cohort study on consecutive patients receiving a colonoscopy at Cheltenham General Hospital, as part of the National Bowel Cancer Screening Program (BCSP) in England. The study included only polyps that were judged as ≤ 7 mm by the colonoscopist. A small sub-mucosal pre-lift injection was administered prior to removal of the polyp using cold biopsy forceps. One or more biopsies were taken until the polyp was confidently assessed visually as being completely removed by the colonoscopist. The entire polypectomy site was then removed en bloc by endomucosal resection (EMR) with a margin of at least 1 to 2 mm around defect. This was sent for histopathological analysis to assess completeness of resection. Polypectomy timing, tissue retrieval, number of bites required for visual resection and complications were recorded at the time of the procedure. RESULTS Sixty-four patients were recruited and consented. Of them, 42 patients had a total of 60 polyps resected. Three patients had inflammatory polyps and were excluded from the study, leaving 57/60 polyps for final analysis. Seventeen were hyperplastic and 40 adenomatous polyps. Retrieval was complete for all 57 polyps and there were no complications both during or post- polypectomy. The complete resection rate (CRR) was 86 %. The technique was more effective in smaller polyps with 91.7 % of diminutive polyps (≤ 5 mm) completely excised. CONCLUSIONS CBPP is a safe and highly effective technique for polyps < 5 mm with a high complete resection and retrieval rate. The time taken for the procedure is significantly greater than cold forceps alone, or cold snare as seen in other studies.
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Affiliation(s)
- Sam A. O’Connor
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, Australia,Department of Gastroenterology, Cheltenham General Hospital, Sandford Road, Cheltenham, UK,Corresponding author Dr Sam A. O’Connor MBBS (Hon), FRACP Princess Alexandra Hospital199 Ipswich RdWoolloongabba QLDAustralia 4102
| | - Trevor N. Brooklyn
- Department of Gastroenterology, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
| | - Paul D. Dunckley
- Department of Gastroenterology, Gloucestershire Royal Hospital, Great Western Rd, Gloucester, UK
| | - Roland M. Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Great Western Rd, Gloucester, UK
| | - Ruth Carr
- Department of Gastroenterology, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
| | - Chris Foy
- Research and Development Unit, Gloucestershire NHS Hospitals Trust, Gloucester, UK
| | - Thusitha Somarathna
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
| | - Lukasz A. Adamczyk
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
| | - Neil A. Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
| | - John T. Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Sandford Road, Cheltenham, UK
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50
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Dwyer JP, Tan JYC, Urquhart P, Secomb R, Bunn C, Reynolds J, La Nauze R, Kemp W, Roberts S, Brown G. A prospective comparison of cold snare polypectomy using traditional or dedicated cold snares for the resection of small sessile colorectal polyps. Endosc Int Open 2017; 5:E1062-E1068. [PMID: 29250580 PMCID: PMC5659868 DOI: 10.1055/s-0043-113564] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 05/22/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS The evidence for efficacy and safety of cold snare polypectomy is limited. The aim of this study was to assess the completeness of resection and safety of cold snare polypectomy, using either traditional or dedicated cold snares. PATIENTS AND METHODS This was a prospective, non-randomized study performed at a single tertiary hospital. Adult patients with at least one colorectal polyp (size ≤ 10 mm) removed by cold snare were included. In the first phase, all patients had polyps removed by traditional snare without diathermy. In the second phase, all patients had polyps removed by dedicated cold snare. Complete endoscopic resection was determined from histological examination of quadrantic polypectomy margin biopsies. Immediate or delayed bleeding within 2 weeks was recorded. RESULTS In total, 181 patients with 299 eligible polyps (n = 93 (173 polyps) traditional snare group, n = 88 (126 polyps) dedicated cold snare group) were included. Patient demographics and procedure indications were similar between groups. Mean polyp size was 6 mm in both groups ( P = 0.25). Complete polyp resection was 165 /173 (95.4 %; 95 %CI 90.5 - 97.6 %) in the traditional snare group and 124/126 (98.4 %; 95 %CI 93.7 - 99.6 %) in the dedicated cold snare group ( P = 0.16). Serrated polyps, compared with adenomatous polyps, had a higher rate of incomplete resection (7 % vs. 2 %, P = 0.03). There was no statistically significant difference in the rate of immediate bleeding (3 % vs. 1 %, P = 0.41) and there were no delayed hemorrhages or perforations. CONCLUSIONS Cold snare polypectomy is effective and safe for the complete endoscopic resection of small (≤ 10 mm) colorectal polyps with either traditional or dedicated cold snares.
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Affiliation(s)
- Jeremy P. Dwyer
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Jonathan Y. C. Tan
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Paul Urquhart
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Robyn Secomb
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Catherine Bunn
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - John Reynolds
- Biostatistics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia 3004
| | - Richard La Nauze
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - William Kemp
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Stuart Roberts
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004
| | - Gregor Brown
- Department of Gastroenterology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia 3004,Corresponding author Associate Professor Gregor Brown Head of EndoscopyAlfred Hospital55 Commercial RdMelbourneVIC 3004Australia+61-3-90762757
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