A prospective randomized study comparing jumbo biopsy forceps to cold snare for the resection of diminutive colorectal polyps

Desai, Shireena; Gupta, Samir; Copur-Dahi, Nedret; Krinsky, Mary Lee

doi:10.1007/s00464-019-06874-z

Cited by 15 publications

(9 citation statements)

References 25 publications

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“…71,72 Our study found that margin biopsies are often positive even after visual inspection of the resection site indicates complete resection. 42,43,[45][46][47][48]50,51 Thus, increasing the resection margins and/or assessing IRR through biopsies should be considered for quality feedback in routine practice. In our study, margin biopsies showed lower IRRs compared with polyp margin assessment (Supplementary Figure 5); however, the tendency to include larger polyps in the polyp margin assessment group could explain these results.…”

Section: Discussionmentioning

confidence: 99%

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Djinbachian¹,

Iratni²,

Durand³

et al. 2020

Gastroenterology

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This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e19. Learning Objective: Upon completion of this CME activity, successful learners will be able to describe key colonoscopy quality metrics and employ proper polypectomy techniques in different clinical situations. BACKGROUND & AIMS: Incomplete resection of neoplastic colorectal polyps can result in postcolonoscopy colorectal cancer. We performed a systematic review and meta-analysis to determine the incomplete resection rate (IRR) of colorectal polyps and associated factors. METHODS: We searched MED-LINE, EMBASE, EBM Reviews, and CINAHL to identify full-text articles that reported IRRs of polyps 1 to 20 mm, published until March 2019. Exclusion criteria were studies of inflammatory bowel disease cohorts, referrals for difficult polypectomy, polyp sizes larger than 20 mm, and endoscopic submucosal resection and/or dissection as polypectomy approaches. IRRs were calculated based on findings from biopsies taken at polypectomy sites or assessments of margins of resected polyps. The primary outcome was IRR for snare removal of polyps 1 to 20 mm. Secondary outcomes included IRR for polyps 1 to 10 mm and 10 to 20 mm, IRR for hot and cold snare removal of polyps 1 to 10 mm and 10 to 20 mm, IRR of snare removal with or without submucosal injection, and IRR for forceps and cold snare removal of polyps 1 to 5 mm. RESULTS: We identified 6148 reports and used 32 studies, with a total of 9282 polyps, in our quantitative analysis. The IRR for snare removal of polyps 1 to 20 mm was 13.8% (95% confidence interval [CI] 10.3-17.3; 13 studies, 5128 polypectomies). IRRs were 15.9% for snare removal of polyps 1 to 10 mm (95% CI 9.6-22.1; 9 studies, 2531 polypectomies) and 20.8% for snare removal of polyps 10 to 20 mm (95% CI 12.9-28.8; 6 studies, 412 polypectomies). The IRR for hot snare removal of polyps 1 to 10 mm was 14.2% (95% CI 5.2-23.2) vs 17.3% for cold snare polypectomy (95% CI 14.3-20.3). The IRR for forceps removal of polyps 1 to 5 mm was 9.9% (95% CI 7.1-13.0) vs 4.4% for snare polypectomy (95% CI 2.9-6.1). CONCLUSIONS: In a systematic review and meta-analysis, we found that colorectal polyps 1 to 20 mm are frequently incompletely resected, and that risk increases for polyps 10 mm or larger. There is no difference in IRRs of cold vs hot snares for polyps 1 to 10 mm. Snare polypectomy should be used over forceps for polyps 1 to 5 mm.

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Section: Discussionmentioning

confidence: 99%

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Djinbachian¹,

Iratni²,

Durand³

et al. 2020

Gastroenterology

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“…There was no heterogeneity (I 2 = 0) among the studies included for analysis. One of the studies, Desai et al [6] contributed to nearly half of the overall analysis while the Gonzalez et al paper [8] had an OR of 4.4 comparing JBF versus CSP that was significantly different from the other studies.…”

Section: Primary Outcomementioning

confidence: 96%

“…Recently, some studies [6][7][8] have been published examining JBF to CSP for efficacy in diminutive polyp resection. However, variable rates have been reported, and it remains unclear which method is better.…”

Section: Conclusion This Systematic Review With Only Limited Datamentioning

confidence: 99%

“…Of the four included articles, three were RCTs [6][7][8], with one study as abstract only data [7] and one was a retrospective cohort study (▶ Table 1) [12]. One of the studies [7] had a noninferiority study design while the others seemed to have followed convenience sampling.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Two of the four studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP ( [7] and [6] respectively). None of the studies provided any long-term follow-up or rates of interval cancer following resection.…”

Section: Secondary Outcomementioning

confidence: 99%

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Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

2021

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Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software. Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

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Endoskopische Diagnostik, Therapie und Nachsorge von Polypen des unteren Gastrointestinaltrakts

2020

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A prospective randomized study comparing jumbo biopsy forceps to cold snare for the resection of diminutive colorectal polyps

Cited by 15 publications

References 25 publications

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Rates of Incomplete Resection of 1- to 20-mm Colorectal Polyps: A Systematic Review and Meta-Analysis

Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

Endoskopische Diagnostik, Therapie und Nachsorge von Polypen des unteren Gastrointestinaltrakts

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