Efficacy of small colon polyps (less than 10 mm) cold polypectomy methods at diagnostic colonoscopy in out-patient clinic

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Efficiency and safety of cold snare polypectomy in patients with colon lesions ≤1.6 cm: two centers experience. Russian Journal of Evidence-Based Gastroenterology. 2023;(4):66-74

The removal of colon polyps is an effective measure of colorectal cancer prevention. For many years electrosurgical methods have been routine, but they have been associated with an increased risk of complications: serositis, bleeding and perforation. Purpose. Of the study was to assess the efficacy and safety of small (less than 10 mm) polypectomies through so-called cold methods — snare or forceps, without the electric cautery, during a diagnostic colonoscopy of out-patients. Material and methods. The surgical radicalism criterion was complete absence of residual polyp tissue at wound edges of the colon mucosa. The results of total 73 colon polypectomies in 50 patients were analized and published in this article. Results. The following techniques were used: cold forceps polypectomy for 35.6% of the polyps (26/73); cold snare polypectomy, with en-bloc resection for 61.6% of the polyps (45/73); cold snare polypectomy supplemented by cold forceps for residual tissues in 2.7% of the polyps (2/73). Slightly elevated polyps (type 0-IIA) 75.3% (55/73); polypoid shape (type 0-Is) 24.6% (18/73). At the same time, the depression area was determined in 16.4% of the polyps. Path morphology diagnosis reported serrated type in 43.8% (32/73), and a non-serrated type was found in 56.2% (41/73) of the polyps. One polyp (1.4%) had a villous structure. No high grade dysplasia or cancer was found. In none of the cases the intervention led to complications. Conclusion. The removal of small (less than 10 mm) colon polyps using cold methods is an efficient and safe technique with a low risk of complications, which can be used at out-patients.

Keywords:

polyps

colon

cold polypectomy

diagnostic colonoscopy

cold snare

cold forceps

Authors:

Ageykina N.V.

Medical Rehabilitation Center of the Ministry of Economic Development of the Russian Federation, Moscow, Russia

Fedorov E.D.

Kafedra gospital'noĭ khirurgii #2 i nauchno-issledovatel'skaia laboratoriia khirurgicheskoĭ gastronterologii i ndoskopii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta im. N.I. Pirogova

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

List of references:

Robertson DJ. Colonoscopy for colorectal cancer prevention: is it fulfilling the promise? Gastrointest Endosc. 2010;71(1):118-120.
https://doi.org/10.1016/j.gie.2009.09.004
Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977-1981.
https://doi.org/10.1056/NEJM199312303292701
Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, Schulman J. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145:880-886.
https://doi.org/10.7326/0003-4819-145-12-200612190-00004
Paspatis GA, Vardas E, Theodoropoulou A, Manolaraki MM, Charoniti I, Papanikolaou N, Chroniaris N, Chlouverakis G. Complications of colonoscopy in a large public county hospital in Greece. A 10-year study. Dig Liver Dis. 2008;40(12):951-957.
https://doi.org/10.1016/j.dld.2008.02.041
Lee Bo-In. Polypectomy of Small Polyps: Technical Updates. IDEN. 2016;280-281.
Renteln D, Pohl H. Polyp Resection — Controversial Practices and Unanswered Questions. Clinical and Translational Gastroenterology. 2017;8(3):e76. https://doi.org/10.1038/ctg.2017.6
Horiuchi A, Nakayama Y, Kajiyama M, Tanaka N, Sano K, Graham DY. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc. 2014;79(3):417-423.
https://doi.org/10.1016/j.gie.2013.08.040
Kawamura T, Takeuchi Y. A comparison of the resection rate for cold and hot snare polypectomy for 4—9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut. 2017;pii: gutjnl-2017-314215.
https://doi.org/10.1136/gutjnl-2017-314215
Murino A, Hassan C, Repici A. The diminutive colon polyp: biopsy, snare, leave alone? Curr Opin Gastroenterol. 2016;32(1):38-43.
https://doi.org/10.1097/MOG.0000000000000230
Matsuura N, Takeuchi Y, Yamashina T, Ito T, Aoi K, Nagai K, Kanesaka T, Matsui F, Fujii M, Akasaka T, Hanaoka N, Higashino K, Tomita Y, Ito Y, Ishihara R, Iishi H, Uedo N. Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study. Endoscopy. 2017;49:251-257.
https://doi.org/10.1055/s-0043-100215
Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, Levy LC, Toor A, Mackenzie TA, Rosch T, Robertson DJ. Incomplete polyp resection during colonoscopyresults of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144:74-80. https://doi.org/10.1053/j.gastro.2012.09.043
Komeda Y, Kashida H. Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy. World J Gastroenterol. 2017;23(2):328-335. https://doi.org/10.3748/wjg.v23.i2.328
Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Hazzan R, Gralnek IM, Gschwantler M, Waldmann E, Jeschek P, Penz D, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter MD, Burgess NG, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49(03):270-297.
https://doi.org/10.1055/s-0043-102569
Lambert R, Lightdale CJ. The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach, and colon — Paris, France November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(suppl 6):3-43.
https://doi.org/10.1016/S0016-5107(03)02159-X
Salvatierra E, Spataro T, Thomas J, Sheth A, Traylor J, Jin L, Minoch A, McLarty J. Regional Differences in Colon Circumference and Wall Thickness. Gastrointestinal Endoscopy. 2010;71(5):W144.
https://doi.org/10.1016/j.gie.2010.03.858
Mönkemüller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004;36(5):432-436.
https://doi.org/10.1055/s-2004-814321
Schett B, Wallner J, Weingart V, Ayvaz A, Richter U, Stahl J, Allescher H-D. Efficacy and safety of cold snare resection in preventive screening colonoscopy. Endosc Int Open. 2017;5(7):580-58.
https://doi.org/10.1055/s-0043-105491
Meier B, Caca K, Fischer A, Schmidt A. Endoscopic management of colorectal adenomas. Ann Gastroenterol. 2017;30(6):592-597. Published online 2017 Sep 23.
https://doi.org/10.20524/aog.2017.0193
Suzuki S, Gotoda T, Kusano C, Ikehara H, Sugita A, Yamauchi M, Moriyama M. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointestinal Endoscopy. 2017;87(4):1095-1103.
https://doi.org/10.1016/j.gie.2017.10.041
Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78-81. https://doi.org/10.1159/000323959
Dwyer JP, Tan JYC, Urquhart P, Secomb R, Bunn C, Reynolds J, La Nauze R, Kemp W, Roberts S, Brown G. A prospective comparison of cold snare polypectomy using traditional or dedicated cold snares for the resection of small sessile colorectal polyps. Endosc Int Open. 2017;5(11):1062-1068.
https://doi.org/10.1055/s-0043-113564

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