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Wen S, He L, Zhao X, Li Y, Lin X, Fu Z, He W, Liu T. Risk factors and prediction model for delayed bleeding after cold snare polypectomy: a retrospective study. Int J Colorectal Dis 2024; 39:113. [PMID: 39037462 PMCID: PMC11263232 DOI: 10.1007/s00384-024-04687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Delayed bleeding (DB) is a serious complication after cold snare polypectomy (CSP) for polyps in the colon. The present study aimed to investigate the incidence and risk factors of DB after CSP and to develop a risk-scoring model for predicting DB. METHODS A retrospective study was conducted in four Chinese medical institutions. 10650 patients underwent CSP from June 2019 to May 2023. The study analyzed the rate of DB and extracted the general clinical information and polyp-related information of patients with postoperative DB. As a control, non-DB patients who received CSP at the same 4 hospitals were analyzed. A multivariate Cox regression analysis was performed to develop the prediction model. The model was further validated using a Kaplan-Meier log-rank analysis, receiver operating characteristic curve (ROC) plot and risk plot. RESULTS In our study, we found a 0.24% rate of DB and the risk factors were history of hypertension, hyperlipidemia, antithrombotics use, antiplatelet use, anticoagulant use, abdominal operation, sigmoid colon lesion, hematoma, cold snare defect protrusion, polyp size, wound size, the grade of wound bleeding, and morphology of Ip. These factors were incorporated into the prediction model for DB after CSP. For 1, 3, and 5 days of bleeding, the AUC of the ROC curve was 0.912, 0.939, and 0.923, respectively. The Kaplan-Meier analysis indicated that the high-risk group had a significantly higher risk of DB than the low-risk group. CONCLUSIONS This study screened the risk factors and established a prediction model of DB after CSP. The results may help preventing and reducing the DB rate after CSP of colorectal polyps.
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Affiliation(s)
- Shuting Wen
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Long He
- Department of Digestive Endoscopy, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Xiying Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Yingting Li
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Xiaofeng Lin
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Zhaoli Fu
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
| | - Wenfang He
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
| | - Tianwen Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Agarwal A, Aziz M, Chuang J, Kumar A, Schlachterman A, Loren D, Kowalski T, Adler D. Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials. Gastrointest Endosc 2023; 98:7-18.e4. [PMID: 36907527 DOI: 10.1016/j.gie.2023.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/07/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND AIMS The practices for resection of diminutive colon polyps vary among endoscopists, and U.S. Multi-Society Task force guidelines recommend use of cold snare polypectomy (CSP) for this purpose. In this meta-analysis, we compared CSP and cold forceps polypectomy (CFP) for resection of diminutive polyps. METHODS Several databases were reviewed to identify randomized controlled trials that compared CSP and CFP for resection of diminutive polyps. The study outcomes of interest were complete resection of all diminutive polyps, complete resection of polyps ≤3 mm in size, failure of tissue retrieval, and polypectomy time. For categorical variables, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated; for continuous variables, mean differences (MDs) with 95% CIs were calculated. Data were analyzed by using a random-effects model, and heterogeneity was assessed by using the I2 statistic. RESULTS We included 9 studies with 1037 patients. Rate of complete resection of all diminutive polyps was significantly higher in the CSP group (OR, 1.68; 95% CI, 1.09-2.58). Subgroup analysis, including jumbo or large-capacity forceps, found no significant difference in complete resection between groups (OR, 1.43; 95% CI, .80-2.56). We found no significant between-groups in the rates of complete resection of polyps ≤3 mm in size (OR, .83; 95% CI, .30-2.31). Rate of failure of tissue retrieval was significantly higher in the CSP group (OR, 10.13; 95% CI, 2.29-44.74). No significant between-group difference was noted in polypectomy time. CONCLUSIONS CFP using large-capacity or jumbo biopsy forceps is noninferior to CSP for complete resection of diminutive polyps.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Sachit Sharma
- Department of Medicine; Division of Gastroenterology
| | - Ashu Acharya
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Amit Agarwal
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA
| | | | - Anand Kumar
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander Schlachterman
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Loren
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Douglas Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.
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Katagiri A, Suzuki N, Nakatani S, Kikuchi K, Fujiwara T, Gocho T, Konda K, Inoki K, Yamamura F, Yoshida H. Submucosal Injection Using Epinephrine-Added Saline in Cold Snare Polypectomy for Colorectal Polyps Shortens Time Required for Resection: A Randomized Controlled Study. Cureus 2023; 15:e39164. [PMID: 37332405 PMCID: PMC10276175 DOI: 10.7759/cureus.39164] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
AIMS Immediate bleeding after cold snare polypectomy (CSP) for colorectal polyps might interfere with confirmation of residuals and prolong the time required for resection. We investigated whether submucosal epinephrine-added saline injection reduces the time required for the CSP procedure. METHODS We conducted a single-center, prospective, randomized controlled trial (clinical trial registration number: UMIN000046770). Patients with colorectal polyps ≤ 10 mm were randomly allocated to either CSP with epinephrine-added submucosal injection (CEMR group) or conventional CSP (CSP group). The primary outcome was the time required for resection defined as the time from the initiation of resection (the first insertion of the snare in the CSP group or the injection needle in the CEMR group) to the end of resection (confirming complete resection endoscopically after recognizing the cessation of immediate bleeding) in each lesion, and the secondary outcome was the time to spontaneous cessation of immediate bleeding after resection defined as the time from ensnaring the lesion to confirming the spontaneous cessation of immediate bleeding. RESULTS A total of 126 patients were randomly assigned. Finally, 261 lesions in 118 patients (CEMR group, n = 59; CSP group, n = 59) were analyzed. The time required for resection calculated using the least-square mean was significantly shorter in the CEMR group (106.3 s, 95% CI 97.5 to 115.4 s) than in the CSP group (130.9 s, 95% CI 121.2 to 140.7 s) (P < 0.001). The time to spontaneous cessation of immediate bleeding was also significantly shorter in the CEMR group (20.4 s, 95% CI 14.3 to 26.5 s) than in the CSP group (74.2 s, 95% CI 67.6 to 80.7 s) (P < 0.001). Neither group had cases requiring hemostasis, perforation, or delayed bleeding. CONCLUSIONS CEMR shortened the time for resection by shortening the time to cessation of immediate bleeding compared with conventional CSP in colorectal polyps ≤ 10 mm.
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Affiliation(s)
- Atsushi Katagiri
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Norihiro Suzuki
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Shinya Nakatani
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Kazuo Kikuchi
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Takahisa Fujiwara
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Toshihiko Gocho
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Kenichi Konda
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Kazuya Inoki
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Fuyuhiko Yamamura
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
| | - Hitoshi Yoshida
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, JPN
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Ishibashi F, Suzuki S, Nagai M, Mochida K, Morishita T. Colorectal cold snare polypectomy: Current standard technique and future perspectives. Dig Endosc 2023; 35:278-286. [PMID: 35962754 DOI: 10.1111/den.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023]
Abstract
It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image-enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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Fatima H, Tariq T, Gilmore A, Kim HN, Tang J, Ghabril M, Abdeljawad K. Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps. J Clin Gastroenterol 2023; 57:294-299. [PMID: 35470299 DOI: 10.1097/mcg.0000000000001699] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. MATERIALS AND METHODS Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. RESULTS We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P =0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P =0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. CONCLUSIONS CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.
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Affiliation(s)
- Hala Fatima
- Division of Gastroenterology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN
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Myung YS, Kwon H, Han J, Lim J, Choi SY, Baeg MK, Han SW. Underwater versus conventional cold snare polypectomy of colorectal polyps 4-9 mm in diameter: a prospective randomized controlled trial. Surg Endosc 2022; 36:6527-6534. [PMID: 35024932 DOI: 10.1007/s00464-022-09013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP) has been reported as safe and effective method for the removal of small colorectal polyps. However, some studies showed low R0 resection rate. Underwater endoscopic mucosal resection is an effective technique to increase the proportions of complete resection. Therefore, the aim was to compare the rate of R0 resection of colorectal polyps 4-9 mm in diameter between conventional CSP (C-CSP) and underwater CSP (U-CSP). METHODS This study was a prospective randomized controlled trial. A total of 198 polyps (4-9 mm) in 110 patients were enrolled between December 2019 and June 2020. The polyps were randomized to be treated with either C-CSP (100 polyps) or U-CSP (98 polyps). RESULTS The R0 resection rate was significantly higher in U-CSP group than in C-CSP groups (84.7% vs. 59.0%; p < 0.001). The polyp retrieval rate of C-CSP and U-CSP was 94.5% and 100% (p = 0.030). The rate of polyp fragmentation of C-CSP and U-CSP group was 5.3% and 0% (p = 0.027). The resection time and retrieval time were longer in C-CSP than U-CSP (45.0 ± 37.7 s vs. 34.1 ± 21.2 s, p = 0.032 and 51.9 ± 67.7 s vs. 12.7 ± 12.4 s, p < 0.001). No clinically significant bleeding or perforation occurred in either group. CONCLUSIONS The results of this study were excellent with U-CSP of 4-9 mm colorectal polyps in terms of R0 resection, polyp retrieval and fragmentation rate, and procedure/retrieval time. Therefore, U-CSP is a safe and effective technique for removing colorectal polyps 4-9 mm in diameter. KCT (0004530).
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Affiliation(s)
- Yu Sik Myung
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea.
| | - Hyuki Kwon
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Jaeho Han
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Jongreul Lim
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Soo Yong Choi
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Myong Ki Baeg
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Sok Won Han
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
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Auriemma F, Sferrazza S, Bianchetti M, Savarese MF, Lamonaca L, Paduano D, Piazza N, Giuffrida E, Mete LS, Tucci A, Milluzzo SM, Iannelli C, Repici A, Mangiavillano B. From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s. World J Gastrointest Surg 2022; 14:632-655. [PMID: 36158280 PMCID: PMC9353749 DOI: 10.4240/wjgs.v14.i7.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/02/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.
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Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
| | - Mario Bianchetti
- Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
| | - Maria Flavia Savarese
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
| | - Lupe Sanchez Mete
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alessandra Tucci
- Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
| | | | - Chiara Iannelli
- Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
| | - Benedetto Mangiavillano
- Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
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Aizawa M, Utano K, Nemoto D, Isohata N, Endo S, Tanaka N, Hewett DG, Togashi K. Risk of Delayed Bleeding after Cold Snare Polypectomy in Patients with Antithrombotic Therapy. Dig Dis Sci 2022; 67:1869-1878. [PMID: 33973083 DOI: 10.1007/s10620-021-06984-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cold snare polypectomy is being increasingly adopted; however, there are few reports of cold snare polypectomy regarding antithrombotic therapy. AIMS This study aimed to investigate the real-world safety of cold snare polypectomy during antithrombotic therapy. METHODS We collected data from consecutive patients undergoing cold snare polypectomy in a single hospital between 2013 and 2017. Indications for cold snare polypectomy were any ≤ 10 mm polyp. The primary outcome was delayed bleeding. We compared rates of delayed bleeding between patients with and without antithrombotic therapy and analyzed risk factors for delayed bleeding using binary logistic regression model with firth procedure. RESULTS In 2152 patients (mean age 67.6 years; male 1411), 4433 colorectal polyps (mean diameter 5.0 mm) underwent cold snare polypectomy. Clipping during the procedure was performed for 5.8%. Delayed bleeding occurred in 0.51% (11/2152) of patients and 0.25% (11/4433) of polyps, but no major delayed bleeding occurred. A total of 244 (11%) patients received antithrombotic therapy. Patients on antithrombotic therapy were older (p < 0.001), more likely male (p < 0.001) and had cold snare polypectomy in the proximal colon (p = 0.011). The rate of delayed bleeding was higher in patients on antithrombotic therapy (1.64% vs. non-antithrombotic therapy 0.37%, p = 0.009). Larger polyp size (> 5 mm), use of clips, and antithrombotic therapy were significant risk factors for delayed bleeding. There was no clear association between specific antithrombotic agents and delayed bleeding. CONCLUSIONS Delayed bleeding after cold snare polypectomy was rare even in patients with antithrombotic therapy, and no major delayed bleeding occurred.
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Affiliation(s)
- Masato Aizawa
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan
| | - Kenichi Utano
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan
| | - Noriyuki Isohata
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan
| | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan
| | - Noriko Tanaka
- Department of Health Data Science Research, Healthy Aging Innovation Center (HAIC), Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan.,Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| | - David G Hewett
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan.
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Kimoto Y, Sakai E, Inamoto R, Kurebayashi M, Takayanagi S, Hirata T, Suzuki Y, Ishii R, Konishi T, Kanda K, Negishi R, Takita M, Ono K, Minato Y, Muramoto T, Ohata K. Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study. Clin Gastroenterol Hepatol 2022; 20:e132-e138. [PMID: 33152541 DOI: 10.1016/j.cgh.2020.10.053] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cold snare polypectomy (CSP) has become the standard resection method for small colorectal polyps (<10 mm). Sessile serrated lesions (SSL) have low prevalence of advanced histology irrespective of size, and thus could be amenable to CSP. In this study, we evaluated the safety and efficacy of CSP for SSLs ≥10 mm. METHODS Between November 2018 and January 2020, we prospectively enrolled 300 consecutive patients who underwent CSP for 474 SSLs ≥10 mm. To delineate SSL borders, indigo carmine chromoendoscopy and/or image-enhanced endoscopy was conducted. Piecemeal CSP (pCSP) was performed in cases where en-bloc resection was difficult. Biopsy specimens were obtained from the margins of the post-polypectomy defect to confirm complete resection. Surveillance colonoscopy was performed to screen for local recurrence. RESULTS All lesions were successfully resected using CSP without submucosal injection. The median diameter of the resected lesions was 14 mm, and pCSP was used to resect 106 (22%) lesions. Post-polypectomy biopsies revealed residual serrated tissue in only one case (0.2%). Adverse events included immediate bleeding in 8 (3%) patients; no delayed bleeding events occurred, irrespective of the use of antithrombotic drugs. During a 7-month median follow-up period, surveillance colonoscopies were performed for 384 lesions (81%), and no local recurrences were detected. CONCLUSIONS CSP without submucosal injection is a safe and effective treatment for SSLs ≥10 mm. UMIN Clinical Trials, Number: UMIN000034763.
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Affiliation(s)
- Yoshiaki Kimoto
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiji Sakai
- Division of Gastroenterology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Rin Inamoto
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Marie Kurebayashi
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Syunya Takayanagi
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomoya Hirata
- Department of Gastroenterology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Yuichiro Suzuki
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Rindo Ishii
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takafumi Konishi
- Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Keisuke Kanda
- Department of Internal Medicine, Kameda Family Clinic, Tateyama, Japan
| | - Ryoju Negishi
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Maiko Takita
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kohei Ono
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yohei Minato
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takashi Muramoto
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
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10
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Ito T, Takahashi K, Tanabe H, Sato K, Goto M, Sato T, Tanaka K, Utsumi T, Fujinaga A, Kawamoto T, Yanagawa N, Moriichi K, Fujiya M, Okumura T. Safety and efficacy of cold snare polypectomy for small colorectal polyps: A prospective randomized control trial and one-year follow-up study. Medicine (Baltimore) 2021; 100:e26296. [PMID: 34115035 PMCID: PMC8202597 DOI: 10.1097/md.0000000000026296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/07/2023] Open
Abstract
TRIAL DESIGN Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy. METHODS Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate. RESULTS A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06). CONCLUSIONS Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.
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Affiliation(s)
- Takahiro Ito
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Keitaro Takahashi
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Hiroki Tanabe
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Keisuke Sato
- Division of Pathology, Asahikawa-Kousei General Hospital, Japan
| | - Mitsuru Goto
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Tomonobu Sato
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Tatsuya Utsumi
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Akihiro Fujinaga
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | - Toru Kawamoto
- Department of Gastroenterology, Asahikawa-Kousei General Hospital
| | | | - Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University
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11
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Kishida Y, Hotta K, Imai K, Ito S, Yabuuchi Y, Yoshida M, Kawata N, Kakushima N, Takizawa K, Ishiwatari H, Matsubayashi H, Ono H. Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis. Dig Endosc 2021; 33:433-440. [PMID: 32573839 DOI: 10.1111/den.13779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Fragmentation of endoscopically resected colorectal polyps during retrieval is one of the limitations for appropriate pathological diagnosis; however, little is known about steps to reduce it. We aimed to evaluate the effect of removing the suction valve button, which is one of the intricate parts of the endoscope, during polyp suction retrieval for fragmentation and pathological diagnosis. METHODS We retrospectively reviewed the polyps retrieved by suctioning. We used the propensity score matching method to adjust for difference between the button-attached and button-removed groups. Outcomes of fragmentation, pathological diagnosis of non-neoplastic polypectomy (NNP), and pathological cut-end among neoplastic lesions were evaluated. RESULTS On the basis of propensity score matching, 322 pairs of cases were selected for analysis. After matching, the difference in the variables between the two groups was closely balanced. The fragmentation rate was significantly different between the groups (button-attached 36.6% vs. button-removed 22.4%, P < 0.001). No significant difference in the NNP rate was observed between the two groups (button-attached 8.4% vs. button-removed 9.9%). The rate of unclear cut-end was lower in the button-removed group than in the button-attached group (16.2% vs. 9.1%, P = 0.010). In the multivariate analysis, button removal was independently associated with reductions of fragmentation (odds ratio [OR] 0.508, P < 0.001) and unclear cut-end (OR 0.503, P = 0.009). Also, NNP was associated with smaller lesion size (OR 0.364, P < 0.001), but not with button removal. CONCLUSIONS Suction valve button removal during polyp suction retrieval was an effective method to decrease the rates of fragmentation and histological unclear margins.
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Affiliation(s)
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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12
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Boscolo Nata F, Tirelli G, Capriotti V, Marcuzzo AV, Sacchet E, Šuran-Brunelli AN, de Manzini N. NBI utility in oncologic surgery: An organ by organ review. Surg Oncol 2020; 36:65-75. [PMID: 33316681 DOI: 10.1016/j.suronc.2020.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
The main aims of the oncologic surgeon should be an early tumor diagnosis, complete surgical resection, and a careful post-treatment follow-up to ensure a prompt diagnosis of recurrence. Radiologic and endoscopic methods have been traditionally used for these purposes, but their accuracy might sometimes be suboptimal. Technological improvements could help the clinician during the diagnostic and therapeutic management of tumors. Narrow band imaging (NBI) belongs to optical image techniques, and uses light characteristics to enhance tissue vascularization. Because neoangiogenesis is a fundamental step during carcinogenesis, NBI could be useful in the diagnostic and therapeutic workup of tumors. Since its introduction in 2001, NBI use has rapidly spread in different oncologic specialties with clear advantages. There is an active interest in this topic as demonstrated by the thriving literature. It is unavoidable for clinicians to gain in-depth knowledge about the application of NBI to their specific field, losing the overall view on the topic. However, by looking at other fields of application, clinicians could find ideas to improve NBI use in their own specialty. The aim of this review is to summarize the existing literature on NBI use in oncology, with the aim of providing the state of the art: we present an overview on NBI fields of application, results, and possible future improvements in the different specialties.
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Affiliation(s)
- Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy; Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", ULSS 6 Euganea, Via Albere 30, 35043, Monselice, PD, Italy.
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Vincenzo Capriotti
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Alberto Vito Marcuzzo
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Erica Sacchet
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Azzurra Nicole Šuran-Brunelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Nicolò de Manzini
- General Surgery Unit, Department of Medical, Surgical and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
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13
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Yamaguchi D, Yoshida H, Ikeda K, Takeuchi Y, Yamashita S, Jubashi A, Yukimoto T, Takeshita E, Yoshioka W, Fukuda H, Tominaga N, Tsuruoka N, Morisaki T, Ario K, Tsunada S, Fujimoto K. Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis. BMC Gastroenterol 2019; 19:192. [PMID: 31744465 PMCID: PMC6862827 DOI: 10.1186/s12876-019-1114-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan. .,Department of Internal Medicine, Saga Medical School, Saga, Japan.
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kei Ikeda
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuki Takeuchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Shota Yamashita
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Amane Jubashi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | | | - Eri Takeshita
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Wataru Yoshioka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hiroko Fukuda
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Naoyuki Tominaga
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Keisuke Ario
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine, Saga Medical School, Saga, Japan.,Faculty of Medicine, International University of Health and Welfare, Fukuoka, Japan
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