A Comparison of Incomplete Resection Rate of Large and Small Colorectal Polyps by Cold Snare Polypectomy

2021 ◽  
Author(s):  
Xianzong Ma ◽  
Xiutang Feng ◽  
Yangjie Li ◽  
Yongqiang Du ◽  
Jiheng Wang ◽  
...  
Keyword(s):  
Colorectal Polyps ◽  
Incomplete Resection ◽  
Resection Rate ◽  
Cold Snare Polypectomy ◽  
Snare Polypectomy

scholarly journals Hot snare vs. cold snare polypectomy for endoscopic removal of 4 – 10 mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies

2019 ◽  
Vol 07 (05) ◽  
pp. E708-E716 ◽  
Author(s):  
Ramprasad Jegadeesan ◽  
Muhammad Aziz ◽  
Madhav Desai ◽  
Tharani Sundararajan ◽  
Venkata Gorrepati ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Final Analysis ◽  
Complete Removal ◽  
Risk Difference ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Cold Snare Polypectomy ◽  
Snare Polypectomy

Abstract Introduction In recent years, cold snare polypectomy (CSP) has increasingly been used over hot snare polypectomy (HSP) for the removal of colorectal polyps (4 – 10 mm in size). However, the optimal technique (CSP vs. HSP), in terms of complete polyp resection and complications, is uncertain. Our aim was to compare incomplete resection rate (IRR) of polyps and complications using CSP vs. HSP. Methods Randomized controlled studies (RCTs) comparing CSP and HSP for removal of 4 – 10 mm colorectal polyps were considered. Studies were included in the analysis if they obtained biopsy specimens from the resection margin to confirm the absence of residual tissue and reported complications. IRR and complication rate were the outcome measures. Pooled rates were reported as Odds Ratios (OR) or risk difference with 95 % Confidence Interval (CI). Results In total, three RCTs were included in the final analysis. A total of 1051 patients with 1485 polyps were randomized to either HSP group (n = 741 polyps) or CSP group (n = 744 polyps). The overall IRR did not differ between the two groups (HSP vs. CSP: 2.4 % vs. 4.7 %; OR 0.51, 95 %CI 0.13 – 1.99, P = 0.33, I 2 = 73 %). The HSP group had a lower rate of overall complications compared to the CSP group (3.7 % vs. 6.6 %; OR 0.53, 95 % CI 0.3 – 0.94, P = 0.03, I 2 = 0 %). Polyp retrieval rates were not different between the two groups (99 % vs. 98.1 %). Conclusion Our results suggest that HSP and CSP techniques can be effectively used for the complete removal of 4 – 10 mm colorectal polyps; however, HSP has a lower incidence of overall complications.

scholarly journals Extended cold snare polypectomy for small colorectal polyps increases the R0 resection rate

2018 ◽  
Vol 06 (02) ◽  
pp. E254-E258 ◽  
Author(s):  
Yasuhiro Abe ◽  
Haruaki Nabeta ◽  
Ryota Koyanagi ◽  
Taro Nakamichi ◽  
Hayato Hirashima ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Colorectal Polyps ◽  
R0 Resection ◽  
Low Grade ◽  
Resection Rate ◽  
Delayed Bleeding ◽  
Mean Size ◽  
Cold Snare Polypectomy ◽  
Baseline Characteristics ◽  
Snare Polypectomy

Abstract Background and study aims Despite widespread use of cold snare polypectomy (CSP), the R0 resection rate is not well documented. We perform extended CSP, resecting polyps with a > 1 mm circumferential margin. The aim of this study is to compare the R0 resection rate of extended CSP with conventional CSP and to assess safety. Patients and methods From April 2014 to September 2016, 712 non-pedunculated colorectal polyps, < 10 mm in size, resected using CSP from 316 patients were retrospectively analyzed. Results We divided lesions into conventional CSP (n = 263) and extended CSP groups (n = 449). The baseline characteristics of these two groups were not significantly different in univariate or multivariate analyses. Sessile polyps comprised 94 % (668/712), and the remaining were flat-elevated polyps. Mean size of polyps (±standard deviation) was 4.2 ± 1.5 mm. The most frequent pathology was low grade adenoma (97 %, 689/712). The R0 resection rate was significantly higher in the extended CSP group (439/449 [98 %]) than in the conventional CSP group (222/263 [84 %], P < 0.001). There was no delayed bleeding or perforation in either group (conventional CSP group, 0/263, 95 % confidence interval: 0.0 – 1.4 % and extended CSP group, 0/449, 95 % confidence interval: 0.0 – 0.8 %). Conclusions Extended CSP results in a higher R0 resection rate compared with conventional CSP. Extended CSP did not result in a higher rate of delayed bleeding or perforation. Extended CSP is a safe and promising procedure for endoscopic resection of non-pedunculated colorectal polyps < 10 mm in size

Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Endoscopy ◽  
2017 ◽  
Vol 50 (04) ◽  
pp. 403-411 ◽  
Author(s):  
Vasilios Papastergiou ◽  
Konstantina Paraskeva ◽  
Maria Fragaki ◽  
Ioannis Dimas ◽  
Emmanouil Vardas ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Saline Solution ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
Established Method ◽  
Mucosal Resection ◽  
Cold Snare Polypectomy ◽  
Clinically Significant ◽  
Noninferiority Margin ◽  
Snare Polypectomy

Abstract Background and study aims Cold snare polypectomy is an established method for the resection of small colorectal polyps; however, significant incomplete resection rates still leave room for improvement. We aimed to assess the efficacy of cold snare endoscopic mucosal resection (CS-EMR), compared with hot snare endoscopic mucosal resection (HS-EMR), for nonpedunculated polyps sized 6 – 10 mm. Patients and methods This study was a dual-center, randomized, noninferiority trial. Consecutive adult patients with at least one nonpedunculated polyp sized 6 – 10 mm were enrolled. Eligible polyps were randomized (1:1) to be treated with either CS-EMR or HS-EMR. Both methods involved submucosal injection of a methylene blue-tinted normal saline solution. The primary noninferiority end point was histological eradication evaluated by postpolypectomy biopsies (noninferiority margin – 10 %). Secondary outcomes included occurrence of intraprocedural bleeding, clinically significant postprocedural bleeding, and perforation. Results Among 689 patients screened, 155 patients with 164 eligible polyps were included (CS-EMR n = 83, HS-EMR n = 81). The overall rate of histological complete resection was 92.8 % in the CS-EMR group and 96.3 % in the HS-EMR group (difference 3.5 %; 95 % confidence interval [CI] – 4.15 to 11.56), showing noninferiority of CS-EMR compared with HS-EMR. CS-EMR was shown to be noninferior both for polyps measuring 6 – 7 mm (CS-EMR 93.3 %; HS-EMR 100 %; 95 %CI – 7.95 to 21.3) and those of 8 – 10 mm (92.5 % vs. 94.7 %, respectively; 95 %CI – 7.91 to 13.16). Rates of intraprocedural bleeding were similar between the two groups (CS-EMR 3.6 %, HS-EMR 1.2 %; P  = 0.30). No clinically significant postprocedural bleeding or perforation occurred in either group. Conclusions CS-EMR appears to be a valuable modification of the standard cold snare technique, obviating the need to use diathermy for nonpedunculated colorectal polyps sized 6 – 10 mm.

Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study

Endoscopy ◽  
2017 ◽  
Vol 49 (03) ◽  
pp. 251-257 ◽  
Author(s):  
Noriko Matsuura ◽  
Yoji Takeuchi ◽  
Takeshi Yamashina ◽  
Takashi Ito ◽  
Kenji Aoi ◽  
...  
Keyword(s):  
Observational Study ◽  
Incomplete Resection ◽  
Resection Rate ◽  
Cold Snare Polypectomy ◽  
Snare Polypectomy

EXTENDED COLD SNARE POLYPECTOMY FOR SMALL COLORECTAL POLYPS INCREASES THE R0 RESECTION RATE

2018 ◽  
Author(s):  
Y Abe ◽  
S Shinozaki ◽  
H Nabeta ◽  
R Koyanagi ◽  
T Nakamichi ◽  
...  
Keyword(s):  
Colorectal Polyps ◽  
R0 Resection ◽  
Resection Rate ◽  
Cold Snare Polypectomy ◽  
Snare Polypectomy

Factors Associated with possibly Inappropriate Histological Evaluation of Excised Specimens in Cold-snare Polypectomy for Small Colorectal Polyps

2018 ◽  
Vol 27 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Yuichi Shimodate ◽  
Junya Itakura ◽  
Motowo Mizuno ◽  
Rio Takezawa ◽  
Mami Kobayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Polyps ◽  
Histological Evaluation ◽  
Incomplete Resection ◽  
Muscularis Mucosae ◽  
Mean Size ◽  
Cold Snare Polypectomy ◽  
Independent Risk Factors ◽  
Negative Tumor ◽  
Snare Polypectomy

Background & Aims: Small colorectal polyps may be removed with cold snare polypectomy (CSP). Some of these polyps may contain unexpectedly advanced neoplasia. Thus, it is important to establish criteria for excision that will ensure that the CSP specimens are adequate for accurate histological assessment. We retrospectively investigated depth of excised small polyps and their vertical margins in patients who underwent CSP.Method: CSP-excised specimens of 376 small colorectal polyps were examined. We histologically evaluated negative tumor vertical margins and complete resection through the muscularis mucosae, which was defined as muscularis mucosae present under the tumor along more than 80% of its horizontal axis. We also evaluated the fragmentation of the retrieved specimens.Results: The mean size of the 376 polyps was 4.9 ±1.4 mm, and 25 polyps (6.6%) had unexpectedly advanced histology. Thirty-two lesions (8.5%) were fragmented. In 275 (79.9%) of the remaining 344 unfragmented polyps, muscularis mucosae resection was judged complete. Vertical margins were confirmed negative in 99.6% (274/275) of polyps that had complete muscularis mucosae resection, but in only 33.3% (23/69) of polyps with incomplete resection. In 79 polyps (21%) (32 fragmented specimens and 47 unfragmented specimens), including 5 polyps with advanced histology, negative vertical margins could not be confirmed. Sessile morphology and location in the cecum were independent risk factors for incomplete muscularis mucosae resection and fragmentation.Conclusion: Incomplete muscularis mucosae resection and fragmentation at retrieval are risk factors for inadequate histological evaluation of CSP-excised small colorectal polyps, especially for sessile polyps and polyps in the cecum.

scholarly journals A prospective comparison of cold snare polypectomy using traditional or dedicated cold snares for the resection of small sessile colorectal polyps

2017 ◽  
Vol 05 (11) ◽  
pp. E1062-E1068 ◽  
Author(s):  
Jeremy Dwyer ◽  
Jonathan Tan ◽  
Paul Urquhart ◽  
Robyn Secomb ◽  
Catherine Bunn ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Randomized Study ◽  
Colorectal Polyps ◽  
Second Phase ◽  
Incomplete Resection ◽  
Polyp Size ◽  
Prospective Comparison ◽  
Significant Difference ◽  
Cold Snare Polypectomy ◽  
Snare Polypectomy

Abstract Background and study aims The evidence for efficacy and safety of cold snare polypectomy is limited. The aim of this study was to assess the completeness of resection and safety of cold snare polypectomy, using either traditional or dedicated cold snares. Patients and methods This was a prospective, non-randomized study performed at a single tertiary hospital. Adult patients with at least one colorectal polyp (size ≤ 10 mm) removed by cold snare were included. In the first phase, all patients had polyps removed by traditional snare without diathermy. In the second phase, all patients had polyps removed by dedicated cold snare. Complete endoscopic resection was determined from histological examination of quadrantic polypectomy margin biopsies. Immediate or delayed bleeding within 2 weeks was recorded. Results In total, 181 patients with 299 eligible polyps (n = 93 (173 polyps) traditional snare group, n = 88 (126 polyps) dedicated cold snare group) were included. Patient demographics and procedure indications were similar between groups. Mean polyp size was 6 mm in both groups (P = 0.25). Complete polyp resection was 165 /173 (95.4 %; 95 %CI 90.5 – 97.6 %) in the traditional snare group and 124/126 (98.4 %; 95 %CI 93.7 – 99.6 %) in the dedicated cold snare group (P = 0.16). Serrated polyps, compared with adenomatous polyps, had a higher rate of incomplete resection (7 % vs. 2 %, P = 0.03). There was no statistically significant difference in the rate of immediate bleeding (3 % vs. 1 %, P = 0.41) and there were no delayed hemorrhages or perforations. Conclusions Cold snare polypectomy is effective and safe for the complete endoscopic resection of small (≤ 10 mm) colorectal polyps with either traditional or dedicated cold snares.

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