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2015 ; 3
(1
): E76-80
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Diminutive colorectal polyp resection comparing hot and cold snare and cold
biopsy forceps polypectomy Results of a pilot randomized, single-center study
(with videos)
#MMPMID26134778
Gómez V
; Badillo RJ
; Crook JE
; Krishna M
; Diehl NN
; Wallace MB
Endosc Int Open
2015[Feb]; 3
(1
): E76-80
PMID26134778
show ga
BACKGROUND: The optimal method of diminutive polypectomy (6?mm) is unknown.
OBJECTIVE: To assess the rates of incomplete resection of diminutive polyps of
the colon using three standard polyp resection techniques (hot snare, cold snare,
and cold biopsy forceps). DESIGN: Randomized, pilot study. SETTINGS:
Single-center endoscopy center. PATIENTS: PATIENTS undergoing routine outpatient
colonoscopies. INTERVENTIONS: Polypectomy was performed using the method to which
the patient was randomized. Following retrieval of the polyp, the polypectomy
base was lifted by submucosal injection of normal saline and then excised using
the cold snare device. If no tissue could be removed, then at least four cold
biopsies using forceps of the remaining margin were obtained. MAIN OUTCOME
MEASURES: Adequacy of resection of diminutive polyps, which was defined as no
visible adenoma or hyperplastic tissue seen in the base tissue on histology.
RESULTS: A total of 60 patients were enrolled (57?% male), the mean age was 60
(range 33?-?82), and 62 polyps were randomized from 37 patients. The mean polyp
size was 3.6?mm (range 2?-?5?mm) and 37 polyps (60?%) were adenomatous. Overall
incomplete polyp resection rate was 9?% (95?%CI 3?-?19?%), 5 of 37 (14?%) for
adenomas. By the study arm, the incomplete resection rates were 1 of 18 (6?%) for
hot snare, 2 of 21 (10?%) for cold snare, and 2 of 18 (11?%) for cold biopsy
forceps. The majority of polyp bases were removed with cold biopsy forceps since
most of the endoscopists did not feel that the saline lift cold snare method was
feasible or appropriate. LIMITATIONS: Small sample size; endoscopic mucosal
resection (EMR) of the polyp base tissue was not routinely performed.
CONCLUSIONS: Recruiting patients to a pilot study that randomized polyps to one
of three common methods of polypectomy for diminutive polyps was feasible, and
approximately 1 in 10 diminutive polyps found on colonoscopy were incompletely
resected by standard polypectomy methods.