Incomplete resection of colorectal polyps of 4–20 mm in size when using a cold snare, and its associated factors

Renteln, Daniel von; Djinbachian, Roupen; Bénard, Florence; Barkun, Alan N.; Bouin, M; Bouchard, Simon; Deslandres, Érik; Panzini, Benoît; Sidani, Sacha; Leduc, Raymond; Jobse, Bruce C.; Pohl, Heiko

doi:10.1055/a-1978-3277

Cited by 9 publications

(10 citation statements)

References 32 publications

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“…Complete resection of colorectal polyps is of obvious importance. It has been estimated that 20 % of post-colonoscopy cancers may be caused by incompletely removed polyps [3].In this issue of Endoscopy, von Renteln et al offer another piece of the puzzle regarding the usefulness of the CSP technique [4]. In their single-center prospective cross-sectional study, the authors investigated the IRR of 128 colorectal polyps sized 4-20 mm.…”

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confidence: 99%

Are we ready for the cold snare revolution?

Holme

2023

Endoscopy

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confidence: 99%

Are we ready for the cold snare revolution?

Holme

2023

Endoscopy

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“…For polyps of 4–10 mm, CSP was recommended as it induce less injury to the submucosal arteries than polypectomy methods using electrocautery ( 19 ). However, The incomplete resection rate can reach 18.4% in a recent study using CSP, ( 20 ) which is worse than a previous study (CARE study) with comparable design using HSP ( 11 ). Evidence comparing efficacy with HSP is lacking.…”

Section: Introductionmentioning

confidence: 61%

Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis

Zhu

et al. 2023

Front. Med.

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Background and study aimsIn recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4–10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods.MethodsWe searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times.ResultsOverall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56–1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11–0.73). In the network meta-analysis for 4–10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3–9.2 vs. OR: 2.6, 95% CI: 1.0–10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], p < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], p = 0.003). Underwater CSP ranked third for complete resection with no complications.ConclusionFor <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4–10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.

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“…A previous study conducted by our research group showed that CSP without SI for 4-to 20-mm colorectal polyps resulted in high IRR (24/128 = 19 %) (12.4 %-26.6 %) [15]. We considered a reduction to 8.5 % to these previous findings as clinically significant for demonstrating clinical superiority of CSP-SI.…”

Section: Sample Size and Statistical Analysismentioning

confidence: 89%

“…A recent meta-analysis indicated that incomplete resection rates (IRRs) when using CSP is high but comparable to IRRs when using hot snare polypectomy (HSP) [14]. A previous study conducted by our research group showed that CSP without SI for 4-to 20-mm colorectal polyps resulted in 19 % IRR [15]. In contrast, another study showed that wide-field cold polypectomy with SI was associated with a much lower IRR (1.2 %) when used for resection of large (> 10 mm) serrated lesions (SLs) [16].…”

Section: Introductionmentioning

confidence: 90%

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Motchum

Djinbachian²,

Rhame

et al. 2023

Endosc Int Open

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Introduction: Incomplete resection of 4–20mm colorectal polyps occur frequently (>10%), putting patients at risk for post-colonoscopy colorectal cancer. We hypothesized that routine use of wide-field cold snare resection with submucosal injection (CSP-SI) might reduce incomplete resection rates (IRRs). Methods: Patients 45–80 years undergoing elective colonoscopies were enrolled in a prospective clinical study. All 4–20mm non-pedunculated polyps were resected using CSP-SI. Post-polypectomy margin biopsies were obtained to determine IRR through histopathology assessment. Primary outcome was IRR, defined as remnant polyp tissue found on margin biopsies. Secondary outcomes included technical success and complication rates. Results: A total of 429 patients (median age 65 years, 47.1% female, adenoma detection rate 40%) with 204 non-pedunculated colorectal polyps 4–20mm removed using CSP-SI were included in the final analysis. CSP-SI was technical successful in 97.5% (199/204) of cases (5 conversion to hot snare polypectomy). IRR for CSP-SI was 3.8% (7/183) [95% CI 2.7–5.5%]. IRR was 1.6% (2/129), 16% (4/25), and 3.4% (1/29) for adenomas, serrated lesions, and hyperplastic polyps respectively. IRR was 2.3% (2/87), 6.3% (4/64), 4.0% (6/151), and 3.1% (1/32) for polyps 4–5mm, 6-9mm, <10mm, and 10–20mm respectively. There was no CSP-SI-related serious adverse event. Conclusion: Use of CSP-SI results in lower IRRs compared to what has previously been reported in the literature for hot or cold snare polypectomy when not using wide-field cold snare resection with submucosal injection. CSP-SI showed an excellent safety and efficacy profile, however comparative studies to CSP without SI are required to confirm these results.

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Incomplete resection of colorectal polyps of 4–20 mm in size when using a cold snare, and its associated factors

Cited by 9 publications

References 32 publications

Are we ready for the cold snare revolution?

Are we ready for the cold snare revolution?

Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

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