A randomized comparison of cold snare polypectomy versus a suction pseudopolyp technique

Din, Said; Ball, Alex; Riley, Stuart; Kitsanta, Panagiota; Johal, S S

doi:10.1055/s-0034-1392533

Cited by 21 publications

(31 citation statements)

References 18 publications

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“…Indeed, the European Society of Gastrointestinal Endoscopy (ESGE) clinical guidelines recommend CSP for the removal of colorectal polyps ≤9 mm in size because of its superior safety profile . However, the R0 resection rate with CSP is not sufficiently high compared with HSP . In a retrospective study from Japan, the R0 resection rate with CSP was significantly lower than that with HSP (47.3% vs 70.5%; P < 0.001) .…”

Section: Discussionmentioning

confidence: 99%

“…This technique uses electrocautery in the underwater environment without mucosal lifting by submucosal injection. Although resection using electrocautery occasionally causes delayed bleeding, this side‐effect was very rare after CSP . Therefore, delayed bleeding was rare even in patients who were taking antithrombotic agents .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…U SE OF COLD snare polypectomy (CSP) has greatly increased in the treatment of diminutive and small colorectal polyps as a result of its excellent safety [1][2][3][4][5][6][7] and remarkable efficacy. [3][4][5][6][7][8][9][10] Recently, the usefulness of CSP not only for colorectal adenomas but also for duodenal adenomas has been reported. 11,12 However, the R0 resection rate with CSP for colorectal adenomas is not yet sufficiently high [3][4][5][6][7][8][9][10] because more than 25% of specimens resected by CSP lacked the muscularis mucosa, which is significantly related to a non-R0 resection result.…”

Section: Introductionmentioning

confidence: 99%

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Underwater cold snare polypectomy for colorectal adenomas

Maruoka

Kishimoto

Matsumura

et al. 2019

Digestive Endoscopy

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Background and Aim Cold snare polypectomy (CSP) is a safe treatment for colorectal adenomas. However, the R0 resection rate is not sufficiently high because of inadequate resection of muscularis mucosa. We hypothesized that CSP in an underwater environment could improve this procedure by helping to safely achieve resection containing the muscularis mucosa. We have named this procedure underwater cold snare polypectomy (UCSP). We aimed to investigate the efficacy and safety of UCSP for colorectal adenomas. Methods Between May 2017 and April 2018, patients diagnosed with colorectal adenomas <9 mm underwent UCSP. After follow‐up colonoscopy 3 weeks later, the patients post‐UCSP scars were biopsied. Outcomes were compared with those of a historical control group who underwent conventional CSP in our previous study using propensity score‐matching methods. Results Overall, 224 lesions in 65 patients were prospectively resected by UCSP. Pathologically, 209 lesions were adenomas (4.5 ± 1.5 mm) including one intramucosal carcinoma. Only one pathological residual adenoma was identified, but there was no significant difference in the residual rate between the UCSP and CSP groups (both 1.0%). No complications were observed. R0 resection rate and rate of area containing the muscularis mucosa in the UCSP group were significantly higher than those in the CSP group (80.2% vs 32.7%, P < 0.001; 50.0% vs 35.3%, P = 0.015). Conclusion Underwater cold snare polypectomy for diminutive and small colorectal adenomas was safe and effective from the perspective of pathological complete resection, which is likely facilitated by achieving an adequate depth of resection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Underwater cold snare polypectomy for colorectal adenomas

Maruoka

Kishimoto

Matsumura

et al. 2019

Digestive Endoscopy

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“…Using a suction pseudopolyp technique, a complete histological excision rate of 98.6 % can be achieved without adverse effects 15 . Cold snare polypectomy proved to be superior to cold forceps polypectomy in polyps > 4 mm with regard to complete resection 16 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of cold snare resection in preventive screening colonoscopy

et al. 2017

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Background and aim Removal of polyps during colonoscopy effectively prevents the development of colorectal cancer. So far, snare resection with high frequency current with or without prior submucosal saline injection is the method of choice. The aim of this study was to evaluate the feasibility, safety, and outcome of cold snare resection during routine endoscopy. Methods In this prospective study, 522 patients undergoing outpatient colonoscopy were included. Cold snare resection for diminutive (< 6 mm), small (6 – 9 mm), and larger polyps (> 9 – 15 mm) was performed using a dedicated cold snare device (Exacto ® ) without prior submucosal injection. Outcome parameters included bleeding rate, perforation rate, procedure time, histologic evaluation of polyp margins, and success rates. The data were compared to a group of patients undergoing hot snare resection. Results Overall, 1233 polyps were removed using cold snare resection with an overall success rate of 99.4 %. All failures of cold snare resection occurred in the cecum (8/82, failure rate 9.8 %). In the remaining colon, the success rate was 100 %. Immediate post-polypectomy bleeding occurred in 0.49 % of all patients and was most frequently seen in polyps larger than 9 mm. The procedure time was significantly shorter using cold snare resection compared with hot snare resection (27.6 min vs. 35.7 min, P < 0.01). Conclusion Cold snare resection can be performed safely in outpatients for removal of small polyps in screening colonoscopy. It does not require prior saline injection and reduces procedure time without an increased risk of bleeding.

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Cold snare polypectomy vs cold forceps biopsy in endoscopic treatment of colonic small and diminutive polyps—Effectiveness and safety in the real world

Chien

Huang

et al. 2018

Adv in Digestive Medicine

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The practice of colonoscopy is used to reduce the risk of colonic malignancy. Complete removal of polyps is required to prevent tumor recurrence and the development of potential interval cancers. However, it is difficult to completely remove the polyp that is more than 4 mm in size through cold forceps biopsy. Polypectomy with a cold snare has been increasingly utilized in recent years, which provides a chance of complete removal of the polyp. This study compares the effectiveness and safety between cold snare polypectomy (CSP) and cold forceps biopsy (CFB) in diminutive or small sessile polyp removal. Between August 2015 and June 2016, 164 consecutive patients with colorectal polyps <10 mm in size were enrolled into either the CSP or CFB group. Demographic data, the duration of colonoscopy withdrawal time, adverse events, and pathological reports were recorded. The primary outcome is complete polyp eradication histologically. The secondary outcomes include rates of adverse events and time taken for the procedures. Of 164 patients, 84 patients were in CSP group and 80 patients in CFB group. The CSP group comprised elder patients (P = 0.042), most of who were male (P = 0.359). There was no significant difference of indications for colonoscopy. The mean withdrawal time was significantly longer in the CSP group (12.5 ± 6.90 minutes vs 9.14 ± 5.45 minutes; P < 0.01). The mean polyp size was bigger in the CSP group (5.05 ± 2.72 mm vs 3.84 ± 1.52 mm, P < 0.05). Eighty‐nine (84.7%) adenomas, 13 (12.4%) hyperplastic polyps, and three other polyps (2.9%) were resected in the CSP group. No high‐grade dysplasia or malignancy was found. Pathological examination showed that 54 polyps were completely removed in CSP group. Thirteen polyps were not removed completely, and 38 polyps could not be surveyed due to tissue destruction during the procedure. In the CFB group, no polyps could be identified with complete removal. The complete histological polyp eradication rate is higher in the CSP group (51.4% vs 0%, P < 0.01). Under operator's discretion, 23 cases with 31 hemoclips were applied for bleeding prevention in the CSP group and only one in the CFB group. However, no further treatment requirement or delayed bleeding event was found in both groups. CSP is an effective method in small or diminutive polyps compared with CFB, and its safety is not inferior to CFB. Given these results and the high prevalence of such polyps, CSP is advocated as an alternate treatment.

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A randomized comparison of cold snare polypectomy versus a suction pseudopolyp technique

Abstract: In this study both polypectomy techniques were found to be safe and highly effective, but further large multicenter trials are required.Clinical trial registration at www.clinicaltrials.gov: NCT02208401.

Cited by 21 publications

References 18 publications

Underwater cold snare polypectomy for colorectal adenomas

Underwater cold snare polypectomy for colorectal adenomas

Efficacy and safety of cold snare resection in preventive screening colonoscopy

Cold snare polypectomy vs cold forceps biopsy in endoscopic treatment of colonic small and diminutive polyps—Effectiveness and safety in the real world

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