Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa

Takayanagi, Daisuke; Nemoto, Daiki; Isohata, Noriyuki; Endo, Shunsuke; Aizawa, Masato; Utano, Kenichi; Kumamoto, Kensuke; Hara, Hiroshi; Lefor, Alan Kawarai; Togashi, Kazutomo

doi:10.1097/dcr.0000000000001109

Cited by 38 publications

(31 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Both adenomas and superficial adenocarcinomas are subject to endoscopic resection. Cold‐snare polypectomy (CSP) is becoming increasingly popular for the resection of adenomas; however, whether CSP is applicable for adenocarcinomas is still under debate, as heat‐induced cancer cell death cannot be anticipated. Real‐time diagnosis as to whether or not polyps are malignant, and real‐time decision as to whether to use cold or hot snare is thus essential for colonoscopists during routine colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

Minoda

Ogino

Chinen

et al. 2019

Digestive Endoscopy

View full text Add to dashboard Cite

Background and Aim The Japan Narrow‐Band Imaging (NBI) Expert Team (JNET) classification is a recently proposed NBI magnifying endoscopy‐based classification system for colorectal tumors. Although the usefulness of this system has been reported by JNET experts, its objective validity remains unclear. We tested its validity and usefulness for the diagnosis of colorectal polyps by including colonoscopy experts and non‐experts as test participants. Methods Forty NBI images of polyps of various JNET types were shown to 22 doctors (11 experts and 11 non‐gastrointestinal [GI] trainees) who had not examined the patients. The doctors diagnosed the polyps based solely on the surface and vessel patterns in the magnified images and the JNET classification system. Concordance rates of their diagnoses with the pathological findings of the polyps were determined, and the results for experts and non‐GI trainees were compared. Results Both for colonoscopy experts and non‐GI trainees, the JNET classification system was particularly useful for classifying polyps as benign or malignant. Although the accuracy rates for classifying polyps into each JNET type varied among colonoscopy experts, those who were familiar with the JNET classification system were able to diagnose polyps with approximately 90% accuracy. Common mistakes were attributable to misunderstandings of the wording in the JNET classification chart and lack of proper training. Conclusion The JNET classification system is a practical approach for the diagnosis of colorectal polyps. Training is required even for experienced colonoscopists to adopt the system properly. Common pitfalls must be shared among colonoscopists to improve the accuracy of the diagnosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

Minoda

Ogino

Chinen

et al. 2019

Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

“…Horiuchi et al reported that the rate of arterial injury in the submucosal layer after HSP is as high as 39%, which is a main cause of post‐polypectomy bleeding . Another study found that 60% of hot resections advanced to the deep submucosa and 20% to the muscularis propria, where the vessel diameter was larger and the number of large vessels was greater . More recently, polyp resection without electrocautery, called CSP, has attracted the attention of colonoscopists because of shorter procedure time and low incidence of adverse events, especially post‐polypectomy bleeding.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Jian

et al. 2018

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…Therefore, for patients taking antithrombotic agents, cold snare polypectomy may be safer than hot snare polypectomy in relation to delayed bleeding. Other recent studies based on pathological analysis also support the notion that cold snare polypectomy causes less damage to deeper submucosal layers involving more large vessels, resulting in the reduced incidence of hemorrhage after cold snare polypectomy …”

Section: Outcomes Of Cold Snare Polypectomymentioning

confidence: 56%

“…Other recent studies based on pathological analysis also support the notion that cold snare polypectomy causes less damage to deeper submucosal layers involving more large vessels, resulting in the reduced incidence of hemorrhage after cold snare polypectomy. 32,33 Recently, direct oral anticoagulants are commonly used in Japan as well as in western countries. However, patients often stop taking direct oral anticoagulants on the day that they undergo colonoscopy.…”

Section: Delayed Bleeding or Perforationmentioning

confidence: 99%

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

Horiuchi

Ikuse

Tanaka

2019

Digestive Endoscopy

View full text Add to dashboard Cite

Colonoscopy has been shown to reduce the risk of colon cancer by enabling the removal of precancerous lesions. Although cold snare and hot snare polypectomy have similar retrieval rates and complete resection rates, rates of delayed bleeding tend to be lower with cold snare polypectomy than with hot snare polypectomy, especially for patients taking antithrombotic agents. However, among cold snares there may be differences in terms of the completeness of polyp excision, as complete removal appears more likely with thin‐wire dedicated cold snares compared to the traditional, thick‐wire cold snares. Cold snare polypectomy may be especially well suited for use in patients taking antithrombotic agents, due to its minimal risk of delayed bleeding. Histological analyses suggest that cold snare polypectomy causes less damage to blood vessels in the submucosal layers, which results in a reduced incidence of hemorrhage compared to hot snare polypectomy. However, cold snare removal of small polyps may result in fragmentation of small specimens during collection and concerns as to whether the resection is complete. An endoscopy biomarker of effective cold snare polypectomy technique is needed to ensure complete removal of non‐pedunculated colorectal polyps ≤10 mm. Future uses of cold snare polypectomy may include piecemeal removal of sessile serrated adenoma/polyp lesions >10 mm. Currently, cold snare polypectomy should be considered a primary method for colorectal polyps of less than 10 mm, especially those in the 4‐ to 10‐mm range.

show abstract

Histological Comparison of Cold versus Hot Snare Resections of the Colorectal Mucosa

Abstract: Hot resection caused damage to deeper layers involving more large vessels. This may explain the mechanism for the reduced incidence of hemorrhage after cold snare polypectomy. See Video Abstract at http://links.lww.com/DCR/A631.

Cited by 38 publications

References 32 publications

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

Objective validity of the Japan Narrow‐Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

Contact Info

Product

Resources

About