Cold Snare Polypectomy Vs. Cold Forceps Polypectomy Using Double-Biopsy Technique for Removal of Diminutive Colorectal Polyps: A Prospective Randomized Study

Abstract

CSP is superior to CFP for the endoscopic removal of DCPs with regard to completeness of polypectomy. CSP technique should be considered the primary method for endoscopic treatment of polyps in the 4-5-mm size range (ClinicalTrials.gov number: NCT01646242).

Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps

“…This agrees with previous studies which found a higher rate of residual lesions after CFP of larger polyps [10,11]. Interestingly, we found that the risk of recurrence was higher after CFP of diminutive right colonic polyps than left colonic ones.…”

“…Several recent studies examined microscopically the presence of residual lesions after CFP by observing specimens obtained immediately by biopsy or endoscopic mucosal resection of post-CFP ulcer edges. The incomplete resection rate ranged from 8 to 38 % [8][9][10][11]. Although these studies revealed a high rate of incomplete resection immediately after CFP of diminutive polyps, that does not necessarily mean that this rate is exactly the same as the real adenoma recurrence rate during follow-up because mechanical disruption of microvasculature and intercellular cohesiveness by CFP could theoretically lead to a loss of residual adenoma tissue.…”

“…Although the reason is not clear, the greater difficulty of manipulating the colonoscope in the right colon may result in incorrect targeting of the biopsy forceps and contribute to the incomplete removal by CFP. Because incomplete polyp resection was related to 10-27 % of interval colorectal cancers [18,19], complete removal of polyps is an [11,[20][21][22]. The recurrence rate and safety of these other resection techniques for diminutive polyps remain to be elucidated.…”

“…Despite the widespread use of standard CFP, there have been only a few studies of the clinical efficacy of this technique, and most of these raised concerns about incomplete polyp eradication [8][9][10][11]. In nonblind prospective studies performed by only one or two experienced endoscopists, microscopic incomplete polyp resection rate ranged from 8 to 38 % [8,10,11].…”

The Histological Quality and Adequacy of Diminutive Colorectal Polyps Resected Using Jumbo Versus Hot Biopsy Forceps

“…After endoscopic resection, the margins of the polypectomy defect should be carefully inspected to ensure the complete removal of all visible pathological tissue. Methods to assess and document complete resection at the time of polypectomy have not been determined, although the taking of biopsies from the base and edges of the polypectomy site is widely used [9,28]. In one study, endoscopic mucosal resection of the polyp base was the method of evaluation of complete resection [10].…”