Cold polypectomy for duodenal adenomas: a prospective clinical trial

Maruoka, Daisuke; Matsumura, Tomoaki; Kasamatsu, Shingo; Ishigami, Hideaki; Taida, Takashi; Okimoto, Kenichiro; Nakagawa, Tomoo; Katsuno, Tatsuro; Arai, Makoto

doi:10.1055/s-0043-107028

Cited by 52 publications

(61 citation statements)

References 27 publications

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“…In a previous report, 96.7% of lesions (mean size, 4.1 mm) were removed en bloc using CSP, and recurrence was not observed. There were also no adverse events [26]. Although the resectable lesion size was small, CSP for small SNADETs seemed to be effective.…”

Section: Characteristics and Treatment Outcome Of Each Er Methodsmentioning

confidence: 99%

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2018

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Background: Endoscopic resection (ER) is becoming the first choice of treatment for treating superficial nonampullary duodenal epithelial tumors (SNADETs), but ER procedures for SNADETs remain challenging because of the difficulty experienced in maneuvering the endoscope toward the thin duodenal wall, which results in a high rate of adverse events. Although several ER methods were used to overcome these technical difficulties and complications, ER methods for SNADETs are not standardized. A new technique, underwater endoscopic mucosal resection (UEMR), was developed recently in a western country, and its usefulness was reported. Beginning in 2014, we were the first to use UEMR for SNADETs in Japan. Thus, in our experience, we would propose an indication of the various ER methods for SNADETs according to the lesion size. Summary: Endoscopic mucosal resection (EMR) and UEMR were effective and safe for small lesions (≤20 mm), but for large lesions (>20 mm), piecemeal removal of lesion by EMR and UEMR had high incidence of recurrence and adverse events. Especially, piecemeal EMR could cause delayed perforation. Cold snare polypectomy was useful for small lesions (≤10 mm), but further study of its recurrence is warranted. Endoscopic submucosal dissection (ESD) achieved a high complete resection rate regardless of the lesion size, but its rate of adverse events, including morbid complications, was high. Thus, after ESD for large lesions, secure prevention method for adverse events, such as closure of the wound by laparoscopic-endoscopic cooperative surgery, should be required. Key Messages: ER methods for treating SNADETs were proposed based on the lesion size. For large lesions, prophylactic methods for adverse events should be implemented.

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Section: Characteristics and Treatment Outcome Of Each Er Methodsmentioning

confidence: 99%

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2018

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“…Thus, SNADETs approximately less than 1 cm are reported to be good targets for this technique, although this may vary depending on the situation [10]. Recently, duodenal cold snare polypectomy has been attempted for small SNADETs less than 1 cm [11]. It is an easy technique and is expected to reduce the risk of delayed perforation or bleeding because there is no thermal damage induced by the high-frequency current.…”

Section: Treatment Methodsmentioning

confidence: 99%

Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors

et al. 2018

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Background: Superficial tumors of the duodenum, other than ampullary tumors, have been traditionally considered rare. However, reports of this kind of tumor have increased in recent times, and the demand for minimally invasive treatments have also increasing. Summary: Adenomas and intramucosal carcinomas are target lesions for treatment. A preoperative diagnosis has not been established, but unnecessary biopsies increase the difficulty of treatment and should be avoided. Cold snare polypectomy, endoscopic mucosal resection (EMR), and underwater EMR are treatment options for small lesions. Endoscopic submucosal dissection enables secure resection even for large lesions, but it is technically demanding and associated with a higher complication rate. After endoscopic resections, exposure of digestive juices is believed to cause delayed complications. To prevent these complications, several closing and covering methods are proposed, with favorable clinical results. Key message: A treatment method should be chosen based on each patient’s situation. With any of the treatment methods, post-resection measures are required to prevent delayed complications. Secure closure of resection wounds seems promising.

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“…Use of cold snare polypectomy (CSP) has greatly increased in the treatment of diminutive and small colorectal polyps as a result of its excellent safety and remarkable efficacy . Recently, the usefulness of CSP not only for colorectal adenomas but also for duodenal adenomas has been reported . However, the R0 resection rate with CSP for colorectal adenomas is not yet sufficiently high 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%

“…[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. 13 Moreover, approximately 80% of protrusions within mucosal defects after CSP contained the muscularis mucosa.…”

Section: Introductionmentioning

confidence: 99%

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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Cold polypectomy for duodenal adenomas: a prospective clinical trial

Cited by 52 publications

References 27 publications

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors

Underwater cold snare polypectomy for colorectal adenomas

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