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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 25, 2015; 7(17): 1250-1256
Published online Nov 25, 2015. doi: 10.4253/wjge.v7.i17.1250
Feasibility of cold snare polypectomy in Japan: A pilot study
Yoji Takeuchi, Takeshi Yamashina, Noriko Matsuura, Takashi Ito, Mototsugu Fujii, Kengo Nagai, Fumi Matsui, Tomofumi Akasaka, Noboru Hanaoka, Koji Higashino, Hiroyasu Iishi, Ryu Ishihara, Henrik Thorlacius, Noriya Uedo
Yoji Takeuchi, Takeshi Yamashina, Noriko Matsuura, Takashi Ito, Mototsugu Fujii, Kengo Nagai, Fumi Matsui, Tomofumi Akasaka, Noboru Hanaoka, Koji Higashino, Hiroyasu Iishi, Ryu Ishihara, Noriya Uedo, Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
Henrik Thorlacius, Department of Clinical Sciences, Section of Surgery, Malmö, Lund University, SE-20502 Malmö, Sweden
Author contributions: Takeuchi Y planned and conducted the study; Takeuchi Y, Yamashina T, Matsuura N, Fujii M, Nagai K, Matsui F, Ito T, Hanaoka N and Uedo N collected the data; Takeuchi Y, Akasaka T, Higashino K, Ishihara R, Iishi H, Thorlacius H and Uedo N assisted with data analysis and interpretation; Takeuchi Y drafted the manuscript; all authors participated in the preparation of this report and approved the final version.
Institutional review board statement: The Local Ethics Committee of Osaka Medical Center for Cancer and Cardiovascular Diseases approved the protocols of this study.
Informed consent statement: Written informed consent was obtained from all patients upon inclusion.
Conflict-of-interest statement: All authors disclose that they have no financial relationships that are relevant to this publication.
Data sharing statement: The technical appendix, statistical code and data set are available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoji Takeuchi, MD, Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
takeuti-yo@mc.pref.osaka.jp
Telephone: +81-6-69721181 Fax: +81-6-69814067
Received: June 14, 2015
Peer-review started: June 15, 2015
First decision: July 10, 2015
Revised: August 24, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: November 25, 2015
Processing time: 163 Days and 23.5 Hours
AIM: To investigate the feasibility of cold snare polypectomy (CSP) in Japan.
METHODS: The outcomes of 234 non-pedunculated polyps smaller than 10 mm in 61 patients who underwent CSP in a Japanese referral center were retrospectively analyzed. The cold snare polypectomies were performed by nine endoscopists with no prior experience in CSP using an electrosurgical snare without electrocautery.
RESULTS: CSPs were completed for 232 of the 234 polyps. Two (0.9%) polyps could not be removed without electrocautery. Immediate postpolypectomy bleeding requiring endoscopic hemostasis occurred in eight lesions (3.4%; 95%CI: 1.1%-5.8%), but all were easily managed. The incidence of immediate bleeding after CSP for small polyps (6-9 mm) was significantly higher than that of diminutive polyps (≤ 5 mm; 15% vs 1%, respectively). Three (5%) patients complained of minor bleeding after the procedure but required no intervention. The incidence of delayed bleeding requiring endoscopic intervention was 0.0% (95%CI: 0.0%-1.7%). In total, 12% of the resected lesions could not be retrieved for pathological examination. Tumor involvement in the lateral margin could not be histologically assessed in 70 (40%) lesions.
CONCLUSION: CSP is feasible in Japan. However, immediate bleeding, retrieval failure and uncertain assessment of the lateral tumor margin should not be underestimated. Careful endoscopic diagnosis before and evaluation of the tumor residue after CSP are recommended when implementing CSP in Japan.
Core tip: Cold snare polypectomy (CSP) was completed for 232 of the 234 polyps. Immediate postpolypectomy bleeding requiring endoscopic hemostasis occurred in eight lesions (3.4%), but all were easily managed. The incidence of immediate bleeding after CSP for small polyps (6-9 mm) was significantly higher than that for diminutive polyps (≤ 5 mm; 15% vs 1%, respectively). Three (5%) patients complained of minor bleeding after the procedure but required no intervention. In total, 12% of the resected lesions could not be retrieved for pathological examination. Tumor involvement in the lateral margin could not be histologically assessed in 70 (40%) lesions.
