Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps

Murakami, Takaaki; Yoshida, Naohisa; Yasuda, Ritsu; Hirose, Ryohei; Inoue, Ken; Dohi, Osamu; Kamada, Kazuhiro; Uchiyama, Kazuhiko; Konishi, Hideyuki; Naito, Yuji; Morinaga, Yukiko; Kishimoto, Mitsuo; Konishi, Eiichi; Ogiso, Kiyoshi; Inada, Yutaka; Itoh, Yoshito

doi:10.1007/s00464-019-07072-7

Cited by 38 publications

(56 citation statements)

References 26 publications

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“…When the scar was not detected by WLI in the follow-up colonoscopy, we evaluated the area three to five times with a help of NBI or BLI, according to previous reports. 10 When a scar was not found with these careful observations, we concluded that the case had no recurrence. We analysed the number of undetected scars and did not exclude these cases in order to prevent an over-estimation of the recurrence rate.…”

Section: Methodsmentioning

confidence: 86%

“…In a previous study, we showed that the rates of recurrence after CSP for 480 lesions <10 mm and 74 lesions 10-14 mm were 1.4% and 5.4%, respectively (p¼0.06). 10 In the study, there were only 7 SSL in lesions 10-14 mm in size, and other histology included 61 low-grade adenomas and 6 lesions with high-grade dysplasia (intramucosal cancer in Japan). Additionally, we tried to achieve en bloc resection for all lesions so that enough margins were not obtained compared to piecemeal CSP.…”

Section: Discussionmentioning

confidence: 98%

“…2,8,9 Additionally, our previous study showed that the rate of local recurrence after CSP for polyps ≥10 mm was higher than that for polyps <10 mm. 10 Thus, CSP is not regularly recommended for neoplastic lesions ≥10 mm.…”

Section: Introductionmentioning

confidence: 99%

“…Operators have to differentiate benign lesions from cancerous lesions by white light image (WLI) and magnifying narrow‐band imaging (NBI) or blue laser imaging (BLI) 2,8,9 . Additionally, our previous study showed that the rate of local recurrence after CSP for polyps ≥10 mm was higher than that for polyps <10 mm 10 . Thus, CSP is not regularly recommended for neoplastic lesions ≥10 mm.…”

Section: Introductionmentioning

confidence: 99%

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Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

et al. 2021

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Background and aim Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. Methods This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10–20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10–14 mm in size to those for lesions 15–20 mm in size. Results We analysed 160 lesions in 100 patients ( Mage± SD=67.7±10.1 years). The polyp size ( M± SD) was 11.8±2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12–24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10–14 mm in size and 15–20 mm in size were 4.7% and 6.3%, respectively ( p=0.713). Conclusion CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.

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Section: Methodsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

et al. 2021

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“…Generally, local recurrence is a major problem after various endoscopic resections for colorectal tumors, and we have previously reported a recurrence rate after cold snare polypectomy (CSP) of 1.9 % [1]. Endoscopic salvage treatment for recurrent neoplasms is sometimes difficult due to fibrosis.…”

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confidence: 99%

Cancer recurrence with severe fibrosis after cold snare polypectomy resected by means of endoscopic submucosal dissection

2020

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Fig. 1 Cold snare polypectomy (CSP) used to treat an intramucosal adenocarcinoma. a Polypoid lesion 5 mm in size on the transverse colon.b An ulcer after CSP showing no definite residual lesion with NBI. c Histopathological diagnosis was intramucosal adenocarcinoma with serrated architecture showing a positive cancer margin. ▶ Fig. 2 Recurrence after CSP. a Recurrent lesion 6 mm in size on the CSP scar. b Magnified narrow-band imaging showed an irregular surface and vessel pattern. c Chromoendoscopy with crystal violet staining showed an irregular pit pattern.

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Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

et al. 2021

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Background: Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. Aim:The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy.Results: Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post-polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5-18%. Lower recurrence rates are found in serrated lesions (<8%).

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Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps

Cited by 38 publications

References 26 publications

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

Cancer recurrence with severe fibrosis after cold snare polypectomy resected by means of endoscopic submucosal dissection

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

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