Feasibility of cold snare polypectomy in Japan: A pilot study

Takeuchi, Yoji; Yamashina, Takeshi; Matsuura, Noriko; Ito, Takashi; Fujii, Masazumi; Nagai, Kengo; Matsui, Futoshi; Akasaka, Tomofumi; Hanaoka, Noboru; Higashino, Koji; Iishi, Hiroyasu; Ishihara, Ryu; Thorlacius, Henrik; Uedo, Noriya

doi:10.4253/wjge.v7.i17.1250

Cited by 72 publications

(96 citation statements)

References 25 publications

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“…Kim et al[11] also demonstrated that the overall complete resection rate was significantly higher in the CSP group than in the CFP (96.6% vs 82.6%, P = 0.01) for polyps ≤ 7 mm. Authors of a pilot study conducted in Japan reported that the rate of complete resection after CSP for polyps < 10 mm was 60%[3]. The present study’s findings showed that the overall complete resection rate for polyps 3-5 mm was significantly higher with CSP than with HFB, although six polyps in the CSP group could not be evaluated because they broke into pieces in the working channel of the scope during aspiration.…”

Section: Discussioncontrasting

confidence: 47%

“…Cold snare polypectomy (CSP) is becoming a common method for resecting small or diminutive polyps without using submucosal injections or electrocautery, and it is regarded as a safe treatment in Western countries[2]. Recently, it has also gradually gained popularity in Japan[3-5]. The advantages of CSP are that electrocautery-related damages to the submucosal vascular tissue are prevented and there are fewer restrictions on patients’ postoperative activity or diet.…”

Section: Introductionmentioning

confidence: 99%

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Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

WJG

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AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.METHODSThis prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely performed.RESULTSTwo hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

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Section: Discussioncontrasting

confidence: 47%

Section: Introductionmentioning

confidence: 99%

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Komeda¹,

Kashida²,

Sakurai³

et al. 2017

WJG

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“…Because, complete removal of the entire mucosal layer is important to avoid recurrence after CSP for small cancers invading the muscularis mucosa, which can be completely removed with endoscopic mucosal resection following submucosal injection. 5 Regarding the high incomplete mucosal layer resection rate (63%), CSP should be used for intra-epithelial lesions only, and careful pretreatment examination is mandatory, even for subcentimeter polyps. Although the incidence of muscularis mucosa residue with CSDP was similar to previous reports and significantly higher than that without CSDP, we believe that a 57% incomplete mucosal layer resection rate is still considerably high.…”

Section: Discussionmentioning

confidence: 99%

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Shichijo

Takeuchi

Kitamura

et al. 2019

J of Gastro and Hepatol

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Background and Aim The true incidence of incomplete muscularis mucosa resection with cold snare polypectomy (CSP) is unknown. We examined the incidence of incomplete muscularis mucosa resection both with and without cold snare defect protrusion (CSDP). Methods We prospectively enrolled patients undergoing polypectomy for 4 to 9mm nonpedunculated polyps. We evaluated the presence of CSDP immediately following CSP and biopsied the CSDP or the center of the mucosal defect without CSDP. The presence of the muscularis mucosa and any residual polyp in the biopsies was evaluated histologically. The primary outcome was the incidence of incomplete mucosal layer resection defined as the presence of muscularis mucosa or residual polyp in the biopsies. Results From August 2017 to October 2018, 188 patients were screened, and 357 polyps were included. CSDP was detected in 122/355 (34%) evaluated mucosal defects. Excluding five lesions requiring hemostasis immediately following CSP, 352 mucosal defects were biopsied. After excluding 102 biopsies containing normal mucosa, we evaluated 250 biopsies. The overall incidence of incomplete mucosal layer resection was 63% (159/250), 76% (68/90) with CSDP and 57% (91/159) without CSDP (P < 0.01). Both univariate and multivariate analyses showed that size (≥ 6 mm), resection time (≥ 5 s), and serrated lesions were risk factors for CSDP. Conclusions Cold snare defect protrusion (CSDP), which was present with 36%, was a good indicator for incomplete mucosal layer resection. Even in nonCSDP polypectomies, 57% of the mucosal layer was not removed completely. Thus, CSP should be used for intra‐epithelial lesions only, and careful pretreatment evaluation is recommended.

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“…In general, CSP is done for benign polyps <10 mm in diameter without a high‐frequency device, and is associated with a low risk of complications; including postoperative hemorrhage . Compared to standard polypectomy, CSP has been reported as a safe procedure even in patients taking warfarin . Furthermore, the procedural time is significantly shorter with CSP than with standard polypectomy …”

Section: Introductionmentioning

confidence: 99%

Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

Hirose

Yoshida

Murakami

et al. 2017

Digestive Endoscopy

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Feasibility of cold snare polypectomy in Japan: A pilot study

Abstract: CSP is feasible in Japan. However, immediate bleeding, retrieval failure and uncertain assessment of the lateral tumor margin should not be underestimated. Careful endoscopic diagnosis before and evaluation of the tumor residue after CSP are recommended when implementing CSP in Japan.

Cited by 72 publications

References 25 publications

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

Does cold snare polypectomy completely resect the mucosal layer? A prospective single‐center observational trial

Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter

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