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Ali S, Khetpal N, Fatima M, Hussain S, Ali A, Khan MA, Childs C, Hasan MK. The Safety of Cold Versus Hot Snare Polypectomy in Polyps 10-20 mm: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e58462. [PMID: 38765346 PMCID: PMC11100549 DOI: 10.7759/cureus.58462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Colonoscopy remains the primary method for preventing colorectal cancer. Traditionally, hot snare polypectomy (HSP) was the method of choice for removing polyps larger than 5 mm. Yet, for polyps smaller than 10 mm, cold snare polypectomy (CSP) has become the favored approach. Lately, the use of CSP has expanded to include the removal of sessile polyps that are between 10 and 20 mm in size. Our systematic review and meta-analysis aimed to evaluate the safety of cold snare polypectomy (CSP) compared to hot snare polypectomy (HSP) for resecting polyps measuring 10-20 mm. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, and Cochrane databases up to April 2020 to find studies that directly compared CSP to HSP for polyps larger than 10 mm. Our main focus was on assessing the risk of delayed bleeding after polypectomy; a secondary focus was the incidence of any adverse events that required medical intervention post procedure. Our search yielded three comparative studies, two observational studies, and one randomized controlled trial (RCT), together encompassing 1,193 polypectomy procedures. Of these, 485 were performed using CSP and 708 with HSP. The pooled odds ratio (OR) for post-polypectomy bleeding (PPB) was 0.36 (95% confidence interval {CI}: 0.02, 7.13), with a Cochran Q test P-value of 0.11 and an I2 of 53%. For the risk of any adverse events necessitating medical care, the pooled OR was 0.15 (95% CI: 0.01, 2.29), with a Cochran Q test P-value of 0.21 and an I2 of 35%. The quality of the two observational studies was deemed moderate, and the RCT was only available in abstract form, preventing quality assessment. Our analysis suggests that there is no significant difference in the incidence of delayed post-polypectomy bleeding or other adverse events requiring medical attention between CSP and HSP for polyps measuring 10-20 mm.
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Affiliation(s)
- Saeed Ali
- Division of Gastroenterology and Hepatology, University of Illinois Chicago, Chicago, USA
| | - Neelam Khetpal
- Department of Hospital Medicine, Hartford Hospital, Hartford, USA
| | - Munazza Fatima
- Department of Anesthesiology, State University of New York (SUNY) Upstate Medical University Hospital, Syracuse, USA
| | - Sana Hussain
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Asad Ali
- Department of Gastroenterology and Hepatology, State University of New York (SUNY) Upstate Medical University Hospital, Syracuse, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Christopher Childs
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, USA
| | - Muhammad K Hasan
- Department of Gastroenterology, Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, USA
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Arimoto J, Chiba H, Yamada K, Nishiguchi T, Kobayashi M, Okada N, Suto T, Niikura T, Kuwabara H, Nakaoka M, Ida T. Cold snare defect protrusion and incomplete polyp resection after forced cold snare polypectomy: a prospective observational study. Endoscopy 2024; 56:14-21. [PMID: 37769690 DOI: 10.1055/a-2183-5505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Cold snare defect protrusions (CSDPs) that occur after cold snare polypectomy (CSP) are considered indicators of incomplete polyp resection (IPR). We have sometimes experienced difficulty resecting polyps with snaring alone; in such cases, a forcible pull on the snare by the endoscopist is necessary. We call this procedure "forced CSP (FCSP)." However, no previous studies have evaluated this procedure. METHODS This was a prospective observational study. From November 2020 to June 2021, the frequency, safety, and validity of FCSP were evaluated at our hospital. We distinguished CSP with snaring alone performed by the assistant as conventional CSP, and CSP requiring a forcible pull on the snare by the endoscopist as FCSP. RESULTS Of 1315 polyps removed, 105 underwent FCSP (8%). The perforation rate was 0% in both groups. The rate of CSDP after the procedure was 96.2% (101/105) with FCSP and 6.4% (77/1210) with conventional CSP (P<0.001). The rate of IPR was 12.5% (13/104) with FCSP and 6.2% (75/1208) with conventional CSP (P=0.02). Multivariable analysis identified polyps located in the cecum (risk ratio [RR], 1.13; 95%CI 1.050-1.179; P=0.003) and polyps ≥6mm in diameter (RR, 2.37; 95%CI 2.146-2.542; P<0.001) as independent risk factors for FCSP. CONCLUSIONS FCSP was performed on 105 polyps (8%) in this study. FCSP may be associated with the occurrence of CSDP and IPR. Further studies are necessary to confirm our results.
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Affiliation(s)
- Jun Arimoto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Hideyuki Chiba
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Keiji Yamada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | - Naoya Okada
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | - Takuma Suto
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
| | | | | | | | - Tomonori Ida
- Gastroenterology, Omori Red Cross Hospital, Ota-ku, Japan
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Kimura K, Ichita C, Sumida C, Nishino T, Nagayama M, Kubota J, Hirose H, Sasaki A. Phlegmonous Colitis after Cold Snare Polypectomy in an Immunosuppressed Patient: A Case Report. Case Rep Gastroenterol 2024; 18:110-116. [PMID: 38455226 PMCID: PMC10919913 DOI: 10.1159/000536487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/19/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Cold snare polypectomy (CSP) is a procedure with a low risk of complications. Here, we present our experience of a rare case of submucosal abscess following CSP in an immunosuppressed patient. Case Presentation Seventy-eight-year-old man underwent CSP, developing a fever, chills, and right lower abdominal pain 8 days later. Ultrasound and computed tomography revealed wall thickening of the ascending colon, presenting as whitening and thickening of the same region, and excretion of pus was observed after biopsy. The diagnosis was made as phlegmonous colitis, for which antibiotic therapy was commenced. The patient was diagnosed with chronic myelomonocytic leukemia (CMML) during admission. We considered the following reasons as possible causes of infectious complications after CSP: (1) the patient had a highly immunosuppressed state with comorbidities such as CMML as well as diabetes mellitus and (2) disruption of the mucosal barrier occurred during endoscopic resection. Conclusion Although CSP is generally considered safe, our case highlights the potential for serious complications in immunosuppressed patients. Therefore, the decision to perform CSP in such patients should be made with caution to avoid unnecessary interventions. In instances where treatment is essential, thorough bowel preparation and prophylactic antibiotic use may be necessary to mitigate the risks.
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Affiliation(s)
- Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Chihiro Sumida
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Miki Nagayama
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Haruto Hirose
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
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Nakaoka M, Chiba H, Kobayashi M, Okada N, Arimoto J, Tachikawa J, Ashikari K, Kuwabara H. Feasibility and Safety of Endoscopic Control for Patients with Serrated Polyposis Syndrome. Dig Dis 2023; 42:31-40. [PMID: 37967542 PMCID: PMC10836738 DOI: 10.1159/000534968] [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: 04/17/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Despite advances in endoscopic treatment, patients with serrated polyposis syndrome (SPS) occasionally require surgery due to numerous or unresectable polyps, recurrence, and treatment-related adverse events. METHODS We retrospectively evaluated 43 patients with SPS undergoing diagnosis and treatment at Omori Red Cross Hospital from 2011 to 2022. Resection of all polyps ≥3 mm in size was planned during the clearing phase; endoscopic control was defined as complete, endoscopic polyp removal. During the surveillance phase, patients underwent annual colonoscopy and resection of newly detected polyps ≥3 mm in size. RESULTS Thirty-eight patients (88%) achieved endoscopic control, two (5%) required surgery after endoscopic treatment because of colorectal cancer (CRC), and three (7%) have not yet achieved endoscopic control and are planning treatment. Endoscopic control was achieved with a median of four colonoscopies at 8 months. Ten polyps (median value) were resected per patient during the clearing phase. Three polyps ≥50 mm in size, six located in the appendiceal orifice, and seven with severe fibrosis could be resected by endoscopic submucosal dissection (ESD). All patients underwent treatment with a combination of cold snare polypectomy (CSP), endoscopic mucosal resection/hot polypectomy, and/or ESD. No case required surgery due to difficulty with endoscopic treatment. Delayed bleeding was observed in 2 cases (0.3%). Twenty-one patients underwent colonoscopies during the surveillance phase. Fifty-three polyps were resected using CSP; no CRC, sessile serrated lesions with dysplasia, or advanced adenoma were detected. CONCLUSION SPS can be effectively, efficiently, and safely controlled with appropriate endoscopic management.
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Affiliation(s)
- Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan,
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Mikio Kobayashi
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
- Department of Gastroenterology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Hiratsuka City Hospital, Hiratsuka, Japan
| | | | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
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Fatima H, Tariq T, Gilmore A, Kim HN, Tang J, Ghabril M, Abdeljawad K. Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps. J Clin Gastroenterol 2023; 57:294-299. [PMID: 35470299 DOI: 10.1097/mcg.0000000000001699] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. MATERIALS AND METHODS Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. RESULTS We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P =0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P =0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. CONCLUSIONS CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.
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Affiliation(s)
- Hala Fatima
- Division of Gastroenterology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
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Chang LC, Chang CY, Chen CY, Tseng CH, Chen PJ, Shun CT, Hsu WF, Chen YN, Chen CC, Huang TY, Tu CH, Chen MJ, Chou CK, Lee CT, Chen PY, Wu MS, Chiu HM. Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps : A Pragmatic Randomized Controlled Trial. Ann Intern Med 2023; 176:311-319. [PMID: 36802753 DOI: 10.7326/m22-2189] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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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Horii T, Suzuki S, Sugita A, Yamauchi M, Ikehara H, Kusano C, Gotoda T. Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study. J Gastroenterol Hepatol 2022; 38:752-760. [PMID: 36565225 DOI: 10.1111/jgh.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) is a standard treatment for small colorectal polyps. This study examined the effect of different snare wire diameters on complete histological resection rate, resection depth, and CSP safety. METHODS This randomized controlled trial was conducted at two institutions between June 2019 and March 2021. Eligible colorectal polyps (≤10 mm) were randomly assigned in a 1:1 ratio to receive either CSP with a conventional snare made of normal-diameter wire (0.40 mm) or CSP with a dedicated snare made of thin wire (0.23 mm). The primary endpoint was the complete resection rate determined on histological assessment of the resected specimen. RESULTS In total, 254 lesions in 152 patients were included, with 128 and 126 lesions assigned to the normal-diameter wire snare group and the thin-wire snare group, respectively. No significant differences were observed in patient characteristics between the two groups. The histological complete resection rate was significantly higher in the thin-wire snare group than in the normal-diameter wire snare group (70.0% vs 81.0%, P = 0.04). The normal-diameter wire snare group had significantly more cases of unclear horizontal margin evaluation than the thin-wire snare group (28.1% vs 15.9%, P = 0.02). No significant differences were observed between the two groups in the muscularis mucosa and submucosa of the resected specimens or the thickness of the submucosa in the resected specimens. CONCLUSIONS CSP with a dedicated thin-wire snare provides more specimens that can be evaluated at the horizontal end and increases the histological complete resection rate.
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Affiliation(s)
- Toshiki Horii
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Chiba, Japan
| | - Akihiro Sugita
- Department of Pathology, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
| | - Misa Yamauchi
- Department of Pathology, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
| | - Hisatomo Ikehara
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Wadhwa V, Patel N, Grover D, Ali FS, Thosani N. Interventional gastroenterology in oncology. CA Cancer J Clin 2022; 73:286-319. [PMID: 36495087 DOI: 10.3322/caac.21766] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
Cancer is one of the foremost health problems worldwide and is among the leading causes of death in the United States. Gastrointestinal tract cancers account for almost one third of the cancer-related mortality globally, making it one of the deadliest groups of cancers. Early diagnosis and prompt management are key to preventing cancer-related morbidity and mortality. With advancements in technology and endoscopic techniques, endoscopy has become the core in diagnosis and management of gastrointestinal tract cancers. In this extensive review, the authors discuss the role endoscopy plays in early detection, diagnosis, and management of esophageal, gastric, colorectal, pancreatic, ampullary, biliary tract, and small intestinal cancers.
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Affiliation(s)
- Vaibhav Wadhwa
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nicole Patel
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Dheera Grover
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Faisal S Ali
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Nirav Thosani
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Gastroenterology Hepatology and Nutrition, University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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Zhu XJ, Yang L. Progression in clinical application of cold snare resection technique in colorectal polyps. Shijie Huaren Xiaohua Zazhi 2022; 30:950-955. [DOI: 10.11569/wcjd.v30.i21.950] [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: 02/07/2023] Open
Abstract
The cold snare resection technique has been recommended by European and American societies and gradually applied in clinical practice. However, due to the operating habits of endoscopists and the insufficient understanding of the cold resection technique, it has not been fully used in colorectal polyps. In this paper, we review the application status of cold snare resection technique, its use in patients treated with antithrombotic drugs, and postoperative histological changes.
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Affiliation(s)
- Xiao-Jia Zhu
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Li Yang
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
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Mi B, Wang H, Liu C, Wang Q, Fu X, Wang Z, Liu F, Li W. Endoscopic follow-up of mucosal defect after hot versus cold snare polypectomy in animal model. J Gastroenterol Hepatol 2022; 37:1090-1095. [PMID: 35234317 DOI: 10.1111/jgh.15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) has received increasing attention in recent years, but few studies have assessed defect repair after polypectomy. Therefore, we compared the repair of mucosal defect after CSP and hot snare polypectomy (HSP) in a rabbit model. METHODS Resection of normal colonic mucosa using both HSP and CSP were performed in 40 male New Zealand white rabbits by an experienced endoscopist. Follow-up colonoscopy was performed after 7 and 15 days by another endoscopist. We assessed mucosal defect repair, status of healing, scar formation, and intraoperative or delayed complications (including perforation and bleeding). RESULTS Eight animals died of intraoperative or delayed perforation; follow-up colonoscopy was performed in 32 animals. On follow-up colonoscopy at 7 days after operation, 78.1% cases in the CSP group showed healing of mucosal defect compared with none in the HSP group (P < 0.001); mucosal repair score in the CSP group was significantly higher than HSP group (P < 0.001). On follow-up colonoscopy at 15 days, mucosal defect after CSP had completely healed in all cases (100%) versus 96.9% after HSP (P = 0.313). Among these healed defects, scar formation was observed in 2 of 32 cases in the CSP group compared with 19 of 31 in the HSP group (P < 0.001). Intraoperative perforation rate was significantly higher in the HSP group (15% vs 2.5%; P = 0.048). CONCLUSIONS Mucosal defect repair after CSP is quicker compared with HSP and is more likely to result in scarless healing. HSP is more likely to cause perforation in the thin colon walls.
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Affiliation(s)
- Biantao Mi
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.,Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Huimin Wang
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunliang Liu
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qi Wang
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaohong Fu
- Department of Gastroenterology and Hepatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Fang Liu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
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11
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Ikeda T, Yoshizaki T, Eguchi T, Kinugasa H, Okada A. Efficacy of specimen pasting after cold snare polypectomy for pathological evaluation of horizontal margins. Endosc Int Open 2022; 10:E572-E579. [PMID: 35571463 PMCID: PMC9106410 DOI: 10.1055/a-1784-6723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Several studies have reported that pathological horizontal margin evaluation cannot be diagnosed in cold snare polypectomy (CSP) specimens. We conducted a prospective randomized controlled trial to determine the efficacy of pasting CSP specimens on paper for pathological horizontal margins. Patients and methods This was a single-center, prospective study conducted at Osaka Saiseikai Nakatsu Hospital. In this study, the indications for CSP were adenomas ≤ 10 mm. Colorectal polyps resected by CSP were randomized to the pasting and non-pasting groups after exclusion of fragmented specimens, and the extended CSP specimens pasted on paper were formalin-fixed in the pasting group. The primary endpoint was rate of unclear horizontal margins after CSP. Results A total of 216 CSP specimens were analyzed. The rate of unclear horizontal margins was significantly lower in the pasting group than in the non-pasting group (15.1 % vs 33.6 %, P = 0.002). CSP specimen pasting significantly reduced the rate of unclear horizontal margins. On multivariate analysis, non-pasting group (odds ratio [OR], 2.69; 95 % confidence interval [CI], 1.38-5.41; P = 0.003) and right colon (OR, 1.98; 95 %CI, 1.01-4.01; P = 0.047) were independent risk factors for unclear horizontal margins in CSP specimens. Conclusions Pasting the extended specimen is important for accurate pathological examination after CSP.
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Affiliation(s)
- Takuya Ikeda
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tetsuya Yoshizaki
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan,Department of Gastroenterology Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takaaki Eguchi
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroshi Kinugasa
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Akihiko Okada
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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12
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Toyosawa J, Yamasaki Y, Fujimoto T, Tanaka S, Tanaka T, Mitsuhashi T, Okada H. Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection. Endosc Int Open 2022; 10:E602-E608. [PMID: 35571476 PMCID: PMC9106413 DOI: 10.1055/a-1785-8616] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens. Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues. Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively ( P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively ( P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR ( P < 0.001, Bonferroni correction). Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.
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Affiliation(s)
- Junki Toyosawa
- Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Tsuyoshi Fujimoto
- Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Shouichi Tanaka
- Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, 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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13
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Uraoka T, Takizawa K, Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano HO, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Saitoh Y, Tsuruta O, Igarashi M, Toyonaga T, Ajioka Y, Fujimoto K, Inoue H. Guidelines for Colorectal Cold Polypectomy (supplement to "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection"). Dig Endosc 2022; 34:668-675. [PMID: 35113465 DOI: 10.1111/den.14250] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 02/08/2023]
Abstract
The Japan Gastroenterological Endoscopy Society published the second edition of the "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front-line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased. Herein, we establish supplementary guidelines for cold polypectomy. Considering that the level of evidence for each statement is limited, these supplementary guidelines must be verified in clinical practice.
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Affiliation(s)
- Toshio Uraoka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kohei Takizawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Yutaka Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naohisa Yahagi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hiro-O Yamano
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shoichi Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takashi Hisabe
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takashi Yao
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Yusuke Saitoh
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Osamu Tsuruta
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Yoichi Ajioka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Haruhiro Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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14
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Arimoto J, Chiba H, Tachikawa J, Yamaoka K, Yamazaki D, Higa A, Okada N, Suto T, Kawano N, Niikura T, Kuwabara H, Nakaoka M, Ida T, Morohashi T, Goto T. Evaluation of cold snare polypectomy for small pedunculated (Ip) polyps with thin stalks: a prospective clinical feasibility study. Scand J Gastroenterol 2022; 57:253-259. [PMID: 34727817 DOI: 10.1080/00365521.2021.1998603] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the use of cold snare polypectomy (CSP) has spread rapidly, no prospective studies evaluating the safety of CSP for pedunculated (Ip) polyps have been carried out. AIM We performed this study to provide an accurate evaluation of the safety of CSP for Ip polyps. METHODS This is a prospective study (UMIN000035687). From January 2019 to February 2021, the safety of CSP for use on Ip polyps <10 mm with thin stalks was evaluated at our hospital. The primary outcome measure was the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding). RESULTS During the study period, 89 consecutive patients (including 92 colonoscopies and 114 polyps) were prospectively enrolled. The en-bloc resection rate was 100%. The rate of DPPB after CSP was 0%, however, DPPB after conversion to HSP occurred in 1 case (33.3% (1/3)). The rate of immediate bleeding during CSP was 28.9% (33/114). Polyps with diameters ≥6 mm (OR (95% CI): 2.77 (1.041-7.376); p = .041) were extracted as independent risk factors for immediate bleeding during CSP for Ip polyps. In all, 104 (91.2%) polyps were low-grade adenomas, and the percentage of cases with negative pathological margins was 96.5% (110/114). CONCLUSIONS CSP for Ip polyps was safe and had good outcomes. We believe that Ip polyps could be included as an indication for CSP, and that CSP may become the next step in the 'cold revolution.' To confirm our results and verify CSP's inclusion in future guidelines, prospective, randomized studies are necessary.
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Kenji Yamaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Dai Yamazaki
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Airi Higa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Takuma Suto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Kawano
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Toshihiro Niikura
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Tomonori Ida
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Taiki Morohashi
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
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15
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Symer M, Connolly J, Yeo H. Management of the Malignant Colorectal Polyp. Curr Probl Surg 2022; 59:101124. [DOI: 10.1016/j.cpsurg.2022.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Oh CK, Choi HS, Cho YS. Comparison of cold snare polypectomy and endoscopic mucosal resection for 3-10-mm colorectal polyps in end-stage renal disease patients. Saudi J Gastroenterol 2021; 28:67-73. [PMID: 34755710 PMCID: PMC8919930 DOI: 10.4103/sjg.sjg_371_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND : Patients with end-stage renal disease (ESRD) have a higher incidence of clinically relevant complications, such as bleeding and perforation after polyp resection, compared to patients without underlying diseases. Cold snare polypectomy (CSP) is increasingly used for the removal of small polyps and diminutive polyps due to its shorter procedure time and low risk of bleeding and perforation. However, there have been few studies on the effectiveness and safety of CSP in patients with ESRD. The aim of this study was to compare the efficacy and safety of CSP and endoscopic mucosal resection (EMR) in ESRD patients. METHODS : This study was a retrospective study. We performed propensity score-matched analysis in patients with ESRD who underwent endoscopic resection for 3-10-mm-sized colorectal polyps at Seoul St. Mary's Hospital, from January 2014 to December 2019. RESULTS : After 1:1 ratio matching, 406 polyps were included: 203 polyps were resected with CSP and 203 polyps with EMR. There was no difference between the CSP group and EMR group in incomplete resection rate (4.43% vs. 1.97%, P = 0.16). There were no differences between the CSP and EMR group for immediate bleeding (5.42% vs. 7.88%, P = 0.32) and delayed bleeding (0% vs. 0.49%, P = 1.00). No perforation occurred in either group. CONCLUSIONS : There were no differences between the CSP and EMR group in terms of efficacy and safety. CSP can be one of the standard methods for the removal of 3-10-mm-sized colorectal polyps in patients with ESRD.
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Affiliation(s)
- Chang Kyo Oh
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Prof. Young-Seok Cho, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul - 06591, Korea. E-mail:
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17
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Fukushima H, Sakamoto N, Shibuya T, Haga K, Nomura O, Murakami T, Ueyama H, Ishikawa D, Hojo M, Nagahara A. A Comparative Study of Early Mucosal Healing Following Hot Polypectomy and Cold Polypectomy. Med Sci Monit 2021; 27:e933043. [PMID: 34432770 PMCID: PMC8404476 DOI: 10.12659/msm.933043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Cold polypectomy (CP) and hot polypectomy (HP) are both accepted methods for polypectomy. In recent years, the use of CP has increased for reasons of safety. However, there have been few investigations of conditions at follow-up early after resection. This prospective study from a single center aimed to compare colonic mucosal healing at 1 week following HP vs CP of benign colonic polyps <10 mm in diameter. Material/Methods Six patients with a total of 52 lesions under 10 mm in size were randomized to either the HP group (n=25) or CP group (n=27) using information in opaque envelopes. One week after endoscopic treatment, the site of treatment was evaluated using colonoscopy. We assessed the mean tumor size, ulcer diameter, exposed blood vessels, residual lesion, and complications. Results Mean tumor size did not differ between the 2 groups (CP vs HP: 5.41 mm vs 5.68 mm). The CP group had a smaller ulcer base diameter (2.70 mm vs 4.84 mm; P<0.05) and fewer exposed blood vessels than the HP group (3.7% vs 36.0%; P<0.05). One residual lesion was found in the CP group. No patients experienced delayed perforation or post-polypectomy bleeding. Conclusions Our study findings showed that at 1-week follow-up, cold polypectomy resulted in improved colonic mucosal healing, with a smaller ulcer diameter and fewer blood vessels, when compared with hot polypectomy.
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Affiliation(s)
- Hirofumi Fukushima
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Dai Ishikawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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18
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Management of Less Than 10-mm-Sized Pedunculated (Ip) Polyps with Thin Stalk: Hot Snare Polypectomy Versus Cold Snare Polypectomy. Dig Dis Sci 2021; 66:2353-2361. [PMID: 32623550 DOI: 10.1007/s10620-020-06436-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the use of cold snare polypectomy (CSP) has spread rapidly, its safety for pedunculated (Ip) polyps remains controversial. In particular, the outcomes of hot snare polypectomy (HSP) and CSP for Ip polyps have not been previously compared. AIMS This study evaluated whether the rate of delayed postpolypectomy bleeding (DPPB) after CSP for Ip polyps was higher than that after HSP for Ip polyps and compared other outcomes (the rates of immediate bleeding and pathological margins) between the HSP and CSP procedures. METHODS A total of 5905 colorectal polyps in 4920 patients were resected at Omori Red Cross Hospital between October 2012 and June 2019. The polyps were divided into two groups: the HSP group (86 polyps, 64 patients) and the CSP group (102 polyps, 87 patients). The primary outcome measure was the incidence of DPPB. The secondary outcome measures were the incidences of immediate bleeding during the procedure and pathological margins of the resected specimen. RESULTS The rate of immediate bleeding during CSP was significantly higher than that for the HSP group [38.2% (39/102) versus 3.5% (3/86); p < 0.001]. However, the rate of DPPB was significantly higher in the HSP group than in the CSP group [4.7% (4/86) versus 0% (0/102); p < 0.001]. The rate of DPPB after CSP was 0%. CONCLUSIONS This is the first study to compare the outcomes of HSP and CSP for Ip polyps. CSP is safer than HSP for Ip polyps measuring < 10 mm in diameter.
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19
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Ito T, Takahashi K, Tanabe H, Sato K, Goto M, Sato T, Tanaka K, Utsumi T, Fujinaga A, Kawamoto T, Yanagawa N, Moriichi K, Fujiya M, Okumura T. Safety and efficacy of cold snare polypectomy for small colorectal polyps: A prospective randomized control trial and one-year follow-up study. Medicine (Baltimore) 2021; 100:e26296. [PMID: 34115035 PMCID: PMC8202597 DOI: 10.1097/md.0000000000026296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023] Open
Abstract
TRIAL DESIGN Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy. METHODS Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate. RESULTS A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06). CONCLUSIONS Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.
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Affiliation(s)
- Takahiro Ito
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Keitaro Takahashi
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Hiroki Tanabe
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Keisuke Sato
- Division of Pathology, Asahikawa-Kousei General Hospital, Japan
| | - Mitsuru Goto
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Tomonobu Sato
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Tatsuya Utsumi
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Akihiro Fujinaga
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Toru Kawamoto
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | | | - Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
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20
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Tanaka S, Saitoh Y, Matsuda T, Igarashi M, Matsumoto T, Iwao Y, Suzuki Y, Nozaki R, Sugai T, Oka S, Itabashi M, Sugihara KI, Tsuruta O, Hirata I, Nishida H, Miwa H, Enomoto N, Shimosegawa T, Koike K. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2021; 56:323-335. [PMID: 33710392 PMCID: PMC8005396 DOI: 10.1007/s00535-021-01776-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Japanese Society of Gastroenterology (JSGE) published ''Daicho Polyp Shinryo Guideline 2014'' in Japanese and a part of this guideline was published in English as "Evidence-based clinical practice guidelines for management of colorectal polyps" in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version. METHODS The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references. RESULTS The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas). CONCLUSIONS After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.
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Affiliation(s)
- Shinji Tanaka
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Minami-ku, KasumiHiroshima, 734-8551, Japan.
| | - Yusuke Saitoh
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takahisa Matsuda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masahiro Igarashi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takayuki Matsumoto
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yasushi Iwao
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yasumoto Suzuki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ryoichi Nozaki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tamotsu Sugai
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Shiro Oka
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Michio Itabashi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ken-Ichi Sugihara
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Osamu Tsuruta
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ichiro Hirata
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroshi Nishida
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroto Miwa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Nobuyuki Enomoto
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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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: 10] [Impact Index Per Article: 2.5] [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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Gao LY, Liu XQ, Huang X. Effect of prophylactic clipping on adverse events after colorectal endoscopic resection: A meta-analysis. Shijie Huaren Xiaohua Zazhi 2020; 28:710-718. [DOI: 10.11569/wcjd.v28.i15.710] [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: 02/07/2023] Open
Abstract
BACKGROUND The effect of prophylactic hemoclip placement on the risk of adverse events such as delayed bleeding and perforation after colorectal polypectomy is still unclear. Its efficiency has not been confirmed and there is no consensus on the usefulness of prophylactic clipping.
AIM To assess the efficacy of prophylactic clipping on adverse events after endoscopic resection of colorectal polyps.
METHODS We performed a search of PubMed, EMBASE, Cochrane library, and Wanfang databases for studies comparing the effect of clipping vs no clipping on adverse events following endoscopic resection. The quality of the included studies was performed. Statistical analysis was performed using Revman5.3 software.
RESULTS We identified seven eligible randomized trials from the database search, involving a total of 3777 patients, which included 1880 patients who used prophylactic hemoclips (clip group) and 1897 who did not use (no clip group). Meta-analysis results showed that the delayed bleeding rate of the clip group was significantly lower than that of the no clip group (2.55% vs 4.48%, P = 0.01, 95%CI: 0.40-0.80). There was no significant difference in postoperative perforation rate between the clip group and no clip group (0.66% vs 1.04%, P = 0.42, 95%CI: 0.21-1.92). Subgroup analysis showed that the prophylactic effect on delayed bleeding was mainly observed in polyps with a size of ≥ 20 mm, and the preventive effect in polyps less than 20 mm was poor (RR = 1.18, 95%CI: 0.62-2.23, P = 0.62; RR = 0.47, 95%CI: 0.29-0.77, P = 0.003). There was no significant difference in the effect of prophylactic hemoclips on the prevention of delayed bleeding after resection of proximal and distal colonic polyps (RR = 0.57, 95%CI: 0.18-1.80, P = 0.34; RR = 0.78, 95%CI: 0.06-10.33, P = 0.85).
CONCLUSION Prophylactic hemoclips can prevent the occurrence of delayed bleeding after colorectal polypectomy, which is mainly observed in the lesions ≥ 20 mm. In addition, hemoclips have little preventive effect on postoperative perforation.
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Affiliation(s)
- Li-Ying Gao
- Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310002, Zhejiang Province, China
| | - Xi-Qiao Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310002, Zhejiang Province, China
| | - Xuan Huang
- Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310002, Zhejiang Province, China
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Arain HA, Wu MLC. Muscularis propria detected at colonic biopsy is not a critical value. Pathol Res Pract 2020; 216:153045. [PMID: 32703480 DOI: 10.1016/j.prp.2020.153045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/16/2020] [Accepted: 05/31/2020] [Indexed: 11/26/2022]
Abstract
Perforation is a rare but potentially serious complication of cold forceps colonic biopsies. The presence of muscularis propria might portend increased risk of perforation and warrant urgent communication with endoscopists. However, identifying muscularis propria at time of biopsy is difficult for many reasons, including histologic overlap with muscularis mucosa. Incidental muscularis propria obtained in this manner has yet to be studied. Our objectives were to characterize the morphology of muscularis propria obtained incidentally via cold forceps colonic biopsies, establish practical criteria for diagnosing muscularis propria, and determine whether diagnosing muscularis propria correlates with perforation clinically. We retrospectively reviewed 3 specimens from nontargeted cold forceps colonic biopsies for which pieces of muscularis propria were presumed to be visualized based on larger size or lower nuclear density compared to the corresponding muscularis mucosa. These specimens were then compared to normal transmural control tissue from colectomy to confirm whether nuclear density or other features could distinguish muscularis propria from muscularis mucosa. Muscularis propria in the control tissue had lower nuclear density, smoother cytoplasmic texture, and more cytoplasmic pallor compared to the muscularis mucosa in the control tissue. This constellation of features was seen in all 3 specimens obtained via biopsy and therefore confirmed the presence of muscularis propria, though all patients lacked perforation clinically. Large size, low nuclear density, smooth cytoplasm, and pale cytoplasm identify objects as muscularis propria at time of colonic biopsy. The presence of muscularis propria fails to correlate with perforation clinically and does not warrant urgent communication.
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Affiliation(s)
| | - Mark Li-Cheng Wu
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, D440 Med Sci 1, Irvine, CA, 92697-4800, USA.
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24
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Safety and efficacy of cold snare polypectomy for pedunculated (Ip) polyps measuring less than 10 mm in diameter. Int J Colorectal Dis 2020; 35:859-867. [PMID: 32112197 DOI: 10.1007/s00384-020-03547-5] [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] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although cold snare polypectomy (CSP) has spread rapidly, it still remains controversial whether CSP is safe for pedunculated (Ip) polyps. PURPOSE The aim of this study was to evaluate whether CSP for Ip polyps measuring less than 10 mm in diameter might be associated with an increased rate of delayed post-polypectomy bleeding (DPPB). METHODS A total of 1641 colorectal polyps in 634 patients were resected at Omori Red Cross Hospital between April 2018 and December 2018. The polyps were divided into two groups depending on the morphology: the Ip group (90 polyps), and the non-Ip group (1551 polyps). RESULTS Among the 1641 polyps, there was no case of DPPB, including in the Ip group. Immediate bleeding occurred in a total of 101 (6.2%) cases. Polyp location in the rectum (OR (95% CI), 3.61 (1.843-7.092); p < 0.001), polyp diameter ≥ 6 mm (OR (95% CI), 2.65 (1.702-4.132); p < 0.001), Ip morphology (OR (95% CI), 15.66 (9.262-26.49); p < 0.001), and treatment with antithrombotic agents (OR (95% CI), 2.18 (1.358-3.501); p = 0.0012) were identified as significant risk factors for immediate bleeding. CONCLUSIONS This is the first study conducted to examine the safety of CSP for Ip polyps measuring less than 10 mm in diameter. CSP can be performed with a high level of safety even for Ip polyps. Based on our findings, we believe that Ip polyps could be included as an indication for CSP. However, prospective, randomized studies are necessary to confirm our results.
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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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Arimoto J, Chiba H, Ashikari K, Fukui R, Anan H, Tachikawa J, Suto T, Kawano N, Niikura T, Kuwabara H, Nakaoka M, Kato S, Ida T, Morohashi T, Goto T, Nakajima A. Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents. Dig Dis Sci 2019; 64:3247-3255. [PMID: 30684074 DOI: 10.1007/s10620-019-5469-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND With the aging of the population and rising incidence of thromboembolic events, the clinical use of antithrombotic agents is also increasing. There are few reports yet on the management of antithrombotic agent use in patients undergoing cold snare polypectomy (CSP). AIMS The aim of this study was to evaluate whether continued administration of antithrombotic agents in patients undergoing CSP would be associated with an increased rate of delayed post-polypectomy bleeding (DPPB). METHODS A total of 1177 colorectal polyps in 501 patients were resected at Omori Red Cross Hospital between October 2017 and March 2018. The polyps were divided into two groups depending on whether the patients received antithrombotic agent treatment or not: the antithrombotic group (911 polyps) and the no-antithrombotic group (266 polyps). RESULTS Among the 1177 polyp resections, there was no case of DPPB, including in the antithrombotic group. Immediate bleeding occurred in a total of 63 (5.4%) cases. Polyp location in the rectum (OR (95% CI) 2.64 (1.223-5.679); p = 0.013), polyp size ≥ 6 mm (OR (95% CI) 4.64 (2.719-7.933); p < 0.001), polypoid growth pattern (OR (95% CI) 2.78 (1.607-4.793); p < 0.001), and antithrombotic agent use (OR (95% CI) 2.98 (1.715-5.183); p < 0.001) were identified as significant risk factors of immediate bleeding. CONCLUSIONS Continued use of antithrombotic agents does not increase the risk of DPPB, even in those receiving multiple antithrombotic agents. Thus, it is safe to perform CSP even in multiple agent users. Prospective, randomized studies are necessary to confirm our results.
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Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan.
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ryo Fukui
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Hideyuki Anan
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Takuma Suto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Naoya Kawano
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Toshihiro Niikura
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomonori Ida
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Taiki Morohashi
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Dua A, Liem B, Gupta N. Lesion Retrieval, Specimen Handling, and Endoscopic Marking in Colonoscopy. Gastrointest Endosc Clin N Am 2019; 29:687-703. [PMID: 31445691 DOI: 10.1016/j.giec.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Retrieval of lesions after endoscopic polypectomy enables histopathologic analysis and guides future surgical management and endoscopic surveillance intervals. Various techniques and devices have been described with distinct advantages and disadvantages to accomplish retrieval. Appropriate histopathologic analysis depends on lesion handling and preparation. How lesions are handled further depends on size, endoscopic appearance, and removal technique. Endoscopic marking or tattooing is a well-described process that uses dye mediums to leave longstanding marks in the colon. Techniques, dye mediums, and locations within the colon influence tattoo approach.
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Affiliation(s)
- Arshish Dua
- Division of Gastroenterology, Loyola University Medical Center, Stritch School of Medicine, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA
| | - Brian Liem
- Gastroenterology Fellowship, Division of Gastroenterology, Stritch School of Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA
| | - Neil Gupta
- Digestive Health Program, Division of Gastroenterology, Stritch School of Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Building 54, Room 167, Maywood, IL 60153, USA.
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Abstract
BACKGROUND Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP. PURPOSE Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP. METHODS Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness. RESULTS Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP. CONCLUSIONS Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.
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Ket SN, Mangira D, Ng A, Tjandra D, Koo JH, La Nauze R, Metz A, Moss A, Brown G. Complications of cold versus hot snare polypectomy of 10-20 mm polyps: A retrospective cohort study. JGH OPEN 2019; 4:172-177. [PMID: 32280761 PMCID: PMC7144768 DOI: 10.1002/jgh3.12243] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/25/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
Abstract
Background and Aim Cold snare polypectomy is safe and efficacious for removing polyps <10 mm with reduced rates of delayed postpolypectomy bleeding and postpolypectomy syndrome. This technique can also be used for sessile polyps ≥10 mm; however, further evidence is required to establish its safety. The aim of this study was to compare intraprocedure and postprocedure adverse events in patients who underwent cold (CSP) versus hot snare polypectomy (HSP) of 10-20 mm sessile colonic polyps. Methods Electronic medical records and endoscopy reports of all patients who underwent polypectomy for Paris 0-IIa, Is, or 0-IIa + Is 10-20 mm colonic polyps between January 2015 and June 2017 at three tertiary academic hospitals and one private hospital were retrospectively reviewed. Data on patient demographics, polyp characteristics, method of polypectomy, and intraprocedural and postpolypectomy adverse events were collected. Results A total of 408 patients (median age 67, 50% male) had 604 polyps, 10-20 mm in size, removed. Of these, 258 polyps were removed by HSP, with a median size of 15 mm (interquartile range [IQR] 12-20), compared to 346 polyps that were removed by CSP, with median size of 12 mm (IQR 10-15), P < 0.001. In the HSP group, 15 patients presented with postprocedure complications, including 11 with clinically significant bleeding, 2 with postpolypectomy syndrome, and 2 with abdominal pain. This compares with no postpolypectomy complications in the CSP group, P < 0.001. Conclusion In this study, CSP was not associated with any postpolypectomy adverse events. CSP appears to be safer than HSP for removing 10-20 mm-sized sessile polyps. A prospective multicenter study has been commenced to verify these findings and to assess the efficacy of CSP for the complete resection of polyps of this size.
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Affiliation(s)
- Shara N Ket
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia.,Central Clinical School Monash University Melbourne Victoria Australia
| | - Dileep Mangira
- Department of Endoscopic Services Western Health Melbourne Victoria Australia.,Department of Medicine - Western Health, Melbourne Medical School University of Melbourne Melbourne Victoria Australia
| | - Allysia Ng
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Douglas Tjandra
- Department of Gastroenterology Melbourne Health Melbourne Victoria Australia
| | - Ja H Koo
- Department of Endoscopic Services Western Health Melbourne Victoria Australia
| | - Richard La Nauze
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia
| | - Andrew Metz
- Department of Gastroenterology Melbourne Health Melbourne Victoria Australia
| | - Alan Moss
- Department of Endoscopic Services Western Health Melbourne Victoria Australia.,Department of Medicine - Western Health, Melbourne Medical School University of Melbourne Melbourne Victoria Australia.,Epworth Hospital Melbourne Victoria Australia
| | - Gregor Brown
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia.,Central Clinical School Monash University Melbourne Victoria Australia.,Epworth Hospital Melbourne Victoria Australia
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30
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Ayoub F, Westerveld DR, Forde JJ, Forsmark CE, Draganov PV, Yang D. Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis. World J Gastroenterol 2019; 25:2251-2263. [PMID: 31143075 PMCID: PMC6526150 DOI: 10.3748/wjg.v25.i18.2251] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/22/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.
AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm.
METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.
RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%) (pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I2 = 0%, P = 0.67).
CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.
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Affiliation(s)
- Fares Ayoub
- Department of Medicine, University of Florida, Gainesville, FL 32608, United States
| | - Donevan R Westerveld
- Department of Medicine, University of Florida, Gainesville, FL 32608, United States
| | - Justin J Forde
- Department of Medicine, University of Florida, Gainesville, FL 32608, United States
| | - Christopher E Forsmark
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
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Jegadeesan R, Aziz M, Desai M, Sundararajan T, Gorrepati VS, Chandrasekar VT, Jayaraj M, Singh P, Saeed A, Rai T, Choudhary A, Repici A, Hassan C, Fuccio L, Sharma P. Hot snare vs. cold snare polypectomy for endoscopic removal of 4 - 10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies. Endosc Int Open 2019; 7:E708-E716. [PMID: 31073538 PMCID: PMC6506415 DOI: 10.1055/a-0808-3680] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction In recent years, cold snare polypectomy (CSP) has increasingly been used over hot snare polypectomy (HSP) for the removal of colorectal polyps (4 - 10 mm in size). However, the optimal technique (CSP vs. HSP), in terms of complete polyp resection and complications, is uncertain. Our aim was to compare incomplete resection rate (IRR) of polyps and complications using CSP vs. HSP. Methods Randomized controlled studies (RCTs) comparing CSP and HSP for removal of 4 - 10 mm colorectal polyps were considered. Studies were included in the analysis if they obtained biopsy specimens from the resection margin to confirm the absence of residual tissue and reported complications. IRR and complication rate were the outcome measures. Pooled rates were reported as Odds Ratios (OR) or risk difference with 95 % Confidence Interval (CI). Results In total, three RCTs were included in the final analysis. A total of 1051 patients with 1485 polyps were randomized to either HSP group (n = 741 polyps) or CSP group (n = 744 polyps). The overall IRR did not differ between the two groups (HSP vs. CSP: 2.4 % vs. 4.7 %; OR 0.51, 95 %CI 0.13 - 1.99, P = 0.33, I 2 = 73 %). The HSP group had a lower rate of overall complications compared to the CSP group (3.7 % vs. 6.6 %; OR 0.53, 95 % CI 0.3 - 0.94, P = 0.03, I 2 = 0 %). Polyp retrieval rates were not different between the two groups (99 % vs. 98.1 %). Conclusion Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4 - 10 mm colorectal polyps; however, HSP has a lower incidence of overall complications.
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Affiliation(s)
- Ramprasad Jegadeesan
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Tharani Sundararajan
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | | | - Viveksandeep Thogulva Chandrasekar
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Mahendran Jayaraj
- Division of Gastroenterology, University of Nevada, Las Vegas, NV, USA
| | - Pratiksha Singh
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Ahmed Saeed
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Tarun Rai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Abhishek Choudhary
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
| | - Alessandro Repici
- Division of Gastroenterology, Humanitas Research Hospital & Humanitas University, Milan, Italy
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, KS, USA
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Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019; 89:929-936.e3. [PMID: 30639542 DOI: 10.1016/j.gie.2018.12.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Hot snare polypectomy and EMR are the standard of care in resecting colorectal polyps ≥10 mm. To avoid the risk of electrocautery-induced damage, there is recent evidence about using cold snare polypectomy and cold EMR for such lesions. The aim of this pooled analysis is to report outcomes of cold snare resection for polyps ≥10 mm. METHODS PubMed/Medline, Embase, Google Scholar, and Cochrane databases were searched up to July 2018 to identify studies that performed cold snare resection for colorectal polyps ≥10 mm. Primary outcomes were adverse events (bleeding, perforation, and postpolypectomy abdominal pain), and secondary outcomes were the rates of complete resection, overall residual polyp rates, and rates for adenomas versus sessile serrated polyps (SSPs). Subgroup analysis was performed focusing on lesion size, location, and resection technique. RESULTS Eight studies were included in the final analysis that included 522 colorectal polyps with a mean polyp size of 17.5 mm (range, 10-60). The overall adverse event rate was 1.1% (95% confidence interval, CI, 0.2%-2.0%; I2 = 0%). Intra- and postprocedural bleeding rates were .7% (95% CI, 0%-1.4%) and .5% (95% CI, .1%-1.2%), respectively, with abdominal pain rate being .6% (95% CI, .1%-1.3%). Polyps ≥20 mm had a higher intraprocedural bleeding rate of 1.3% (95% CI, .7%-3.3%) and abdominal pain rate of 1.2% (95% CI, .7%-3.0%) but no delayed bleedings. No perforations were reported. The complete resection rate was 99.3% (95% CI, 98.6%-100%). Overall pooled residual rates of polyps of any histology, adenomas, and SSPs were 4.1% (95% CI, .2%-8.4%), 11.1% (95% CI, 4.1%-18.1%), and 1.0% (95% CI, .4%-2.4%), respectively, during a follow-up period ranging from 154 to 258 days. CONCLUSIONS The results of this systematic review and pooled analysis were excellent with cold snare resection of colorectal polyps >10 mm in terms of postpolypectomy bleeding, complete resection, and residual polyp rates. Randomized controlled trials comparing cold snare resection with hot snare resections of polyps ≥10 mm are required for further investigation.
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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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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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Matsumoto M, Yoshii S, Shigesawa T, Dazai M, Onodera M, Kato M, Sakamoto N. Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication. Digestion 2018; 97:76-81. [PMID: 29393134 DOI: 10.1159/000484219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. METHODS The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. RESULTS CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6-9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1-5 mm). CONCLUSION CP is a safe procedure even in patients on antithrombotic medication.
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Affiliation(s)
- Mio Matsumoto
- Department of Gastroenterology, Hokkaido Medical Center, Sapporo, Japan
| | - Shinji Yoshii
- Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan
| | - Taku Shigesawa
- Department of Gastroenterology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Masayoshi Dazai
- Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan
| | - Manabu Onodera
- Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan
| | | | - Naoya Sakamoto
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Chen YN, Chang LC, Chang CY, Chen PJ, Chen CY, Tseng CH, Chiu HM. Comparison of cold and hot snaring polypectomy for small colorectal polyps: study protocol for a randomized controlled trial. Trials 2018; 19:361. [PMID: 29980220 PMCID: PMC6035397 DOI: 10.1186/s13063-018-2743-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background Colorectal cancer remains a considerable challenge in healthcare nowadays. Most patients’ disease develops via the adenoma–carcinoma sequence; colonoscopy with polypectomy effectively reduces both mortality and incidence by removing precancerous adenomas. Previous studies showed that polypectomy without electrocautery (cold snaring polypectomy) is a safe and time-saving procedure to manage polyps < 10 mm. However, randomized controlled trials have failed to prove the superiority of cold snaring polypectomy for reducing the risk of delayed bleeding in comparison with hot snaring polypectomy, generally because of their low statistical power that was limited by sample sizes. In this study, we aim to compare the risk of delayed bleeding following cold and hot snaring polypectomy based on a large sample size. Methods This is a prospective multicentre randomized controlled trial to compare cold and hot snaring polypectomy for the treatment of small colorectal polyps. A total of 4258 patients with small polyps (4–10 mm) will be randomized 1:1 to each group. Colonoscopy and polypectomy will be performed by 17 experienced endoscopists at six study sites. The randomization will be performed via an online website. Pathological examination using image-enhanced endoscopy with either narrow-band imaging or chromoendoscopy will be conducted to confirm optically and histologically that complete resections have been achieved, respectively. The primary outcome measurement is the risk of delayed bleeding. The secondary outcome measurements include the number of hemoclip applications, complete eradication confirmed optically and histologically, tissue retrieval rate, procedure time, emergency unit visits, and any adverse events such as immediate bleeding or perforation. Discussion We hypothesize that cold snaring polypectomy can reduce the risk of delayed bleeding by avoiding thermal injury. In addition, this study will also compare cold and hot snaring polypectomy in terms of the complete eradication rate and procedure time. Based on data collected, we will demonstrate that cold snaring polypectomy is a safe, effective, and economic procedure for small colorectal polyps. The results will also provide additional data on which to develop recommendations for treating small colorectal polyps. Trial registration ClinicalTrials.gov, NCT03373136. Registered on 29 November 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2743-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yen-Nien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Cheng-Hao Tseng
- Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, 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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Ma MX, Bourke MJ. Sessile Serrated Adenomas: How to Detect, Characterize and Resect. Gut Liver 2018; 11:747-760. [PMID: 28494577 PMCID: PMC5669590 DOI: 10.5009/gnl16523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
Serrated polyps are important contributors to the burden of colorectal cancers (CRC). These lesions were once considered to have no malignant potential, but currently up to 30% of all CRC are recognized to arise from the serrated neoplasia pathway. The primary premalignant lesions are sessile serrated adenomas/polyps (SSA/Ps), although traditional serrated adenomas are relatively uncommon. Compared to conventional adenomas, SSA/Ps are morphologically subtle with indistinct borders, may be difficult to detect endoscopically, are more prevalent than previously thought, are associated with synchronous and metachronous advanced neoplasia, and have a higher risk of incomplete resection. Although many lesions remain “dormant,” progressive disease is associated with the development of dysplasia and more rapid progression to CRC. As a result, SSA/Ps are strongly implicated in the development of interval cancers. These factors represent unique challenges that require a meticulous approach to their management. In this review, we summarize the contemporary literature on the characterization, detection and resection of SSA/Ps.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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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: 98] [Impact Index Per Article: 16.3] [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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Shimodate Y, Mizuno M, Takezawa R, Kobayashi M, Yamazaki T, Doi A, Nishimura N, Mouri H, Matsueda K, Yamamoto H. Safety of cold polypectomy for small colorectal neoplastic lesions: a prospective cohort study in Japan. Int J Colorectal Dis 2017; 32:1261-1266. [PMID: 28730368 DOI: 10.1007/s00384-017-2856-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cold polypectomy has been widely accepted for removal of small colorectal polyps. However, no large-scale prospective study exists as for its safety in Japan. We investigated this issue in this single-center, prospective cohort study in a total of 1198 colorectal polyps resected with cold polypectomy. PATIENTS AND METHODS Four hundred and seventy-four patients who underwent cold polypectomy for colorectal neoplastic lesions less than 10-mm diameter between September 2014 and October 2016 were enrolled. Primary outcome was the incidence of delayed bleeding within 2 weeks after the procedure. Secondary outcomes were the rate of immediate bleeding, perforation, endoscopic en bloc resection, and advanced histology. RESULTS Cold polypectomy was performed on 1198 polyps in the 474 patients. No delayed bleeding or colonic perforation was observed. Immediate bleeding during the procedure, requiring endoscopic hemostasis, occurred in 97 lesions (8.1%), and all of them were successfully managed endoscopically. The endoscopic en bloc resection rate was 97.2%. Twenty-eight lesions (2.3%) were histologically diagnosed as advanced neoplasia; among them, three lesions were well-differentiated adenocarcinomas, and in two of them, a negative margin was not histologically confirmed. CONCLUSIONS Cold polypectomy for small colorectal polyps is a safe technique without significant complication, but careful endoscopic diagnosis at cold polypectomy is necessary to identify advanced neoplasia. The reliability of cold polypectomy in excision of polyps with high-grade neoplasia should be established before the procedure becomes standard in the excision of small colorectal polyps. CLINICAL TRIAL REGISTRATION NUMBER UMIN000014812.
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Affiliation(s)
- Yuichi Shimodate
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Rio Takezawa
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Mami Kobayashi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Naoyuki Nishimura
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
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Sun HH, Huang SL, Bai Y. Comment on "Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis". World J Gastroenterol 2017; 23:6007-6008. [PMID: 28932094 PMCID: PMC5583587 DOI: 10.3748/wjg.v23.i32.6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/28/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
This is a comment on a meta-analysis of published studies comparing cold vs hot polypectomy. We believe that the conclusion of this meta-analysis that “cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy” needs more rigorous evidence.
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Affiliation(s)
- Huan-Huan Sun
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Si-Lin Huang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yang Bai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis. Surg Endosc 2017; 32:1149-1159. [PMID: 28812188 DOI: 10.1007/s00464-017-5786-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although cold polypectomy techniques are preferred over polypectomy with electrocautery in the management of diminutive polyps, comprehensive comparisons among various cold polypectomy techniques have not yet been fully performed. METHODS We searched for all relevant randomized controlled trials published up until October 2016 examining the efficacy of cold polypectomy techniques for diminutive polyps. Cold polypectomy techniques were classified as cold forceps polypectomy (CFP), jumbo forceps polypectomy (JFP), traditional cold snare polypectomy (CSP), and dedicated CSP, according to the type of device. A network meta-analysis was performed to calculate the direct and indirect estimates of efficacy among the cold polypectomy techniques. RESULTS Seven studies with 703 patients and 968 polyps were included in the meta-analysis. Regarding comparative efficacy for complete histological eradication, there was no inconsistency in the network (Cochran's Q test, df = 4, P = 0.22; I 2 = 30%). In terms of complete histological eradication, both dedicated and traditional CSP were superior to CFP (odds ratio [OR] [95% confidence interval [CI]] 4.31 [1.92-9.66] and 2.45 [1.30-4.63], respectively); dedicated CSP was superior to traditional CSP (OR [95% CI] 1.76 [1.07-2.89]); and there was no difference between JFP versus CFP (OR [95% CI] 1.36 [0.40-4.61]). Regarding tissue retrieval rate, there was no difference between dedicated versus traditional CSP (OR [95% CI] 1.03 [0.44-2.38]). The procedure time for CSP was comparable to that of CFP. CONCLUSIONS Dedicated CSP was shown to be superior to other cold polypectomy techniques in terms of complete histological eradication. Cold polypectomy using a dedicated snare can be recommended for the removal of diminutive colorectal polyps.
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Yamamoto T, Suzuki S, Kusano C, Yakabe K, Iwamoto M, Ikehara H, Gotoda T, Moriyama M. Histological outcomes between hot and cold snare polypectomy for small colorectal polyps. Saudi J Gastroenterol 2017; 23:246-252. [PMID: 28721979 PMCID: PMC5539679 DOI: 10.4103/sjg.sjg_598_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM To compare the complete resection rate of hot and cold snare polypectomy for small colorectal polyps. PATIENTS AND METHODS We retrospectively reviewed the medical records of 233 consecutive patients with 461 colorectal polyps up to 10 mm in diameter that were treated by hot or cold snare polypectomy between April 2014 and August 2016. Lesions treated by hot snare polypectomy (n = 137) and cold snare polypectomy (n = 324) were compared. The histological complete resection rates were evaluated between the two groups. We analyzed the relationship between factors for complete resection and clinical factors using multivariate analysis. RESULTS There was a significantly higher complete resection rate in hot snare polypectomy than in cold snare polypectomy (70.5% vs. 47.3%; P < 0.001). In the analysis of subgroups categorized according to polyp size, the complete resection rate for hot snare polypectomy was significantly higher than that for cold snare polypectomy among polyps ≥6 mm (69.0% vs. 43.5%; P < 0.001). Among polyps ≤5 mm, no significant difference regarding the complete resection rate was observed between the methods (81.3% vs. 53.4%; P = 0.057). There was no significant difference in the incidence of adverse events between the two groups. Multivariate analysis revealed that using hot snare polypectomy (odds ratio 3.03; P < 0.001), small lesion size (odds ratio 1.57; P = 0.049), and lesion location in the left colon (odds ratio 1.73; P = 0.007) were independent factors for complete resection. CONCLUSION Hot snare polypectomy provides a higher complete resection rate than does cold snare polypectomy for larger (6-10 mm) subcentimeter colorectal polyps.
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Affiliation(s)
- Toshiki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan,Department of Gastroenterology, Yuri-Kumiai General Hospital, Akita, Japan,Address for correspondence: Dr. Sho Suzuki, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan. E-mail:
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan,Department of Gastroenterology, Yuri-Kumiai General Hospital, Akita, Japan
| | - Kyoko Yakabe
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Maho Iwamoto
- 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
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Ma MX, Bourke MJ. Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon. Best Pract Res Clin Gastroenterol 2016; 30:749-767. [PMID: 27931634 DOI: 10.1016/j.bpg.2016.09.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/25/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
Endoscopic resection (ER), including endoscopic polypectomy (EP), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used to remove superficial neoplasms from the colon. Snare resection is used for EP and EMR, whereas endoscopic knives are used to perform dissection in the submucosal space in ESD. 80-90% colonic polyps are <10 millimetres (mm) and are effectively managed by conventional EP. Increasingly cold snare polypectomy is preferred. Large laterally spreading lesions (LSLs) and sessile polyps ≥20 mm are primarily removed by EMR. ESD may be used when superficial invasive disease is suspected and for some LSLs, particularly non-granular subtypes. Resection of colonic lesions by ER is associated with a small but definite incidence of significant complications, most commonly bleeding and perforation. This review discusses complications of ER with a particular focus on their prevention, early recognition and management. In many cases, complications from all three procedures share similar mechanisms and management principles and these are described at the start of each section, followed by a description of specific aspects for individual procedures.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia.
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