Complete Polyp Resection with Cold versus Hot snare Polypectomy for Polyps sized 4-9 mm: A randomized controlled trial

Background and study aims: Endoscopic screening with polypectomy reduces colorectal cancer (CRC) incidence. Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) regarding complete polyp resection. Patients and methods: We included patients ≥ 40 years at 8 hospitals in 4 countries who had at least one 4-9 mm non-pedunculated polyp detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP with a non-inferiority margin of 5%. Logistic regression models were fitted to identify factors explaining incomplete resection. Results: In total, 425 patients, with 608 polyps were randomized to either CSP or HSP. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7%) and 21 (7.4%) were incompletely resected, respectively, with an adjusted risk difference of 3.2% (95% CI -1.4 – 7.8). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated, odds ratio (OR) 3.96, (95% CI 1.63-9.66) and hyperplastic histology, OR 2.52 (95% CI 1.30-4.86)) in adjusted analyses. Conclusion: In this randomized trial, non-inferiority for cold snare polypectomy could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared to adenomas. Cold snare polypectomy for small polyps can be used safely in routine colonoscopy practise.

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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

Endoscopy International Open ◽

10.1055/a-0808-3680 ◽

2019 ◽

Vol 07 (05) ◽

pp. E708-E716 ◽

Cited By ~ 5

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.

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Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study

Endoscopy ◽

10.1055/a-1243-0379 ◽

2020 ◽

Author(s):

Ina B. Pedersen ◽

Michael Bretthauer ◽

Mette Kalager ◽

Magnus Løberg ◽

Geir Hoff ◽

...

Keyword(s):

Risk Factors ◽

Subsequent Development ◽

Distal Colon ◽

Colorectal Polyps ◽

Resection Margins ◽

Incomplete Resection ◽

Endoscopic Screening ◽

Logistic Regression Models ◽

Incomplete Removal ◽

Independent Risk Factors

Background Endoscopic screening with polypectomy has been shown to reduce colorectal cancer incidence in randomized trials. Incomplete polyp removal and subsequent development of post-colonoscopy cancers may attenuate the effect of screening. This study aimed to quantify the extent of incomplete polyp removal. Methods We included patients aged 50–75 years with nonpedunculated polyps ≥ 5 mm removed during colonoscopy at four hospitals in Norway. To evaluate completeness of polyp removal, biopsies from the resection margins were obtained after polypectomy. Logistic regression models were fitted to identify factors explaining incomplete resection. Results 246 patients with 339 polyps underwent polypectomy between January 2015 and June 2017. A total of 12 polyps were excluded due to biopsy electrocautery damage, and 327 polyps in 246 patients (mean age 67 years [range 42–83]; 52 % male) were included in the analysis. Overall, 54 polyps (15.9 %) in 54 patients were incompletely resected. Histological diagnosis of the polyp (sessile serrated lesions vs. adenoma, odds ratio [OR] 10.9, 95 % confidence interval [CI] 3.9–30.1) and polyp location (proximal vs. distal colon, OR 2.8, 95 %CI 1.0–7.7) were independent risk factors for incomplete removal of polyps 5–19 mm. Board-certified endoscopists were not associated with lower rates of incomplete resection compared with trainees (14.0 % vs. 14.2 %), OR 1.0 (95 %CI 0.5–2.1). Conclusion Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees.

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