Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching

BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.

Cold snare polypectomy:A closer look at the efficacy and limitations for polyps 10-20 mm in size

Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.

Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis

AIM: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events.METHODS: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords “cold polypectomy”. RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients’ demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias.RESULTS: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group.CONCLUSION: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.

Comment on 'Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis'

This is a comment on a meta-analysis of published studies comparing cold vs hot polypectomy. We believe that the conclusion of this meta-analysis that "cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy" needs more rigorous evidence.

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.METHODSThis prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely performed.RESULTSTwo hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

Feasibility of cold snare polypectomy in Japan: A pilot study

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 requiringendoscopic 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.

Effect of cold snare polypectomy for small colorectal polyps

BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.

Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas.However,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly difficult.Due to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard treatment.Despite having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be frequent.These events are primarily caused by electrocautery-induced damage.Thus,ER techniques with a better safety profile are needed to overcome these shortcomings.Cold snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas.The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.