A simple and cost-effective method: piecemeal cold snare polypectomy without injection for a large sessile serrated lesion ≥20 mm.
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ABSTRACT:
SUBMITTER: Kimoto Y
PROVIDER: S-EPMC7332670 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
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A simple and cost-effective method: piecemeal cold snare polypectomy without injection for a large sessile serrated lesion ≥20 mm.
Kimoto Yoshiaki Y Suzuki Yuichiro Y Sakai Eiji E Ohata Ken K
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20200430 7
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| S-EPMC7649831 | biostudies-literature
Project description:Comparing the efficacy of cold snare polypectomy with endoscopic mucosal resection
| 2230090 | ecrin-mdr-crc
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| S-EPMC6119232 | biostudies-literature
Project description:Background and study aims Incomplete resection of 4- to 20-mm colorectal polyps occur frequently (> 10 %), putting patients at risk for post-colonoscopy colorectal cancer. We hypothesized that routine use of wide-field cold snare resection with submucosal injection (CSP-SI) might reduce incomplete resection rates (IRRs). Patients and methods Patients aged 45 to 80 years undergoing elective colonoscopies were enrolled in a prospective clinical study. All 4- to 20-mm non-pedunculated polyps were resected using CSP-SI. Post-polypectomy margin biopsies were obtained to determine IRRs through histopathology assessment. The primary outcome was IRR, defined as remnant polyp tissue found on margin biopsies. Secondary outcomes included technical success and complication rates. Results A total of 429 patients (median age 65 years, 47.1 % female, adenoma detection rate 40 %) with 204 non-pedunculated colorectal polyps 4 to 20 mm removed using CSP-SI were included in the final analysis. CSP-SI was technical successful in 97.5 % (199/204) of cases (5 conversion to hot snare polypectomy). IRR for CSP-SI was 3.8 % (7/183) (95 % confidence interval [CI] 2.7 %-5.5 %). IRR was 1.6 % (2/129), 16 % (4/25), and 3.4 % (1/29) for adenomas, serrated lesions, and hyperplastic polyps respectively. IRR was 2.3 % (2/87), 6.3 % (4/64), 4.0 % (6/151), and 3.1 % (1/32) for polyps 4 to 5 mm, 6 to 9 mm, < 10 mm, and 10 to 20 mm, respectively. There were no CSP-SI-related serious adverse events. Conclusions Use of CSP-SI results in lower IRRs compared to what has previously been reported in the literature for hot or cold snare polypectomy when not using wide-field cold snare resection with submucosal injection. CSP-SI showed an excellent safety and efficacy profile, however comparative studies to CSP without SI are required to confirm these results.
| S-EPMC10191736 | biostudies-literature
Project description:Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens. Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues. Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively ( P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively ( P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR ( P < 0.001, Bonferroni correction). Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.
| S-EPMC9106413 | biostudies-literature
Project description: Not available
| S-EPMC6004032 | biostudies-literature
Project description:BackgroundEndoscopic mucosal resection (EMR) appears to be a promising technique for the removal of sessile serrated polyps (SSPs) ≥ 10 mm. To assess the effectiveness and safety of EMR for removing SSPs ≥ 10 mm, we conducted this systematic review and meta-analysis.MethodsWe conducted a thorough search of Embase, PubMed, Cochrane, and Web of Science databases for relevant studies reporting on EMR of SSPs ≥ 10 mm, up until December 2023. Our primary endpoints of interest were rates of technical success, residual SSPs, and adverse events (AE).ResultsOur search identified 426 articles, of which 14 studies with 2262 SSPs were included for analysis. The rates of technical success, AEs, and residual SSPs were 100%, 2.0%, and 3.1%, respectively. Subgroup analysis showed that the technical success rates were the same for polyps 10-19 and 20 mm, and en-bloc and piecemeal resection. Residual SSPs rates were similar in en-bloc and piecemeal resection, but much lower in cold EMR (1.0% vs. 4.2%, P = 0.034). AEs rates were reduced in cold EMR compared to hot EMR (0% vs. 2.9%, P = 0.168), in polyps 10-19 mm compared to 20 mm (0% vs. 4.1%, P = 0.255), and in piecemeal resection compared to en-bloc (0% vs. 0.7%, P = 0.169).ConclusionsEMR is an effective and safe technique for removing SSPs ≥ 10 mm. The therapeutic effect of cold EMR is superior to that of hot EMR, with a lower incidence of adverse effects.Prospero registration numberCRD42023388959.
| S-EPMC10953062 | biostudies-literature
Project description:Endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma. The use of cautery carries a risk of delayed bleeding, post-polypectomy syndrome, and perforation. We examined the safety and feasibility of removing colonic and duodenal polyps ≥ 1 cm using a piecemeal cold snare polypectomy technique.The study included 15 patients with duodenal polyps ≥ 1 cm and 15 patients with colonic polyps ≥ 1 cm.Bleeding, perforation, abdominal pain, or hospitalization occurring within 2 weeks of polypectomy.Between 24 August 2011 and 29 April 2013, 15 patients had removal of duodenal polyps ≥ 1 cm. Mean patient age was 64 years and 9/15 patients were male. The mean polyp size was 24 mm (10 - 60 mm). All polyps were removed with a cold snare and some required cold biopsy forceps. One patient required hospitalization for gastrointestinal blood loss 7 days post-polypectomy; this patient was using Coumadin. Between 27 February 2012 and 30 May 2013, 15 patients underwent resection of a ≥ 1 cm colonic polyp. Mean patient age was 68 years and 9/15 were male. The mean polyp size was 20 mm (10 - 45 mm). All polyps were primarily removed with a cold snare. None of the patients required hemostatic clips for control of immediate bleeding. One patient presented to the emergency department with abdominal pain 1 day after initial endoscopy. CT scan showed no abnormalities and the patient was discharged.Cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery-based endoscopic resection. Comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods.
| S-EPMC4612226 | biostudies-other
Project description:ObjectivesWe compared the frequency of post-polypectomy bleeding or injured submucosal arteries between cold snare polypectomy (CSP) and endoscopic mucosal resection (EMR) for nonpedunculated colorectal polyps.MethodsThis was a prospective, randomized, single-center study. Patients who underwent CSP or EMR for 10-19-mm nonpedunculated polyps were enrolled in CSP and EMR groups, and we compared the patient and polyp characteristics, the number of clips used, clinical outcomes, adverse events, and pathological features of the resected polyps between these groups. The primary outcome was the presence of injured arteries in the submucosal layer of the resected polyps examined histologically. The secondary outcomes were immediate bleeding and delayed bleeding.ResultsFifty-three patients with 60 eligible polyps were enrolled. The numbers of polyps/patients were 30/26 in the CSP group and 30/27 in the EMR group. The patient and polyp characteristics were similar between the groups. The total number of hemostatic clips used for hemostasis or prophylactic clipping was significantly greater in the EMR group compared to the CSP group (78 vs. 10, p < 0.001). The frequency of immediate bleeding after CSP was similar to that after EMR [6.7% (2/30) vs. 13% (4/30), p = 0.39]. Delayed bleeding did not occur in either group. The presence of injured submucosal arteries after CSP was significantly less frequent than that after EMR: 10% (3/30) versus 67% (20/30), p < 0.001.ConclusionsIn the resection of 10-19-mm nonpedunculated colorectal polyps, CSP may decrease post-polypectomy bleeding without prophylactic clipping compared to EMR as it results in fewer injured submucosal arteries. www.clinicaltrials.gov (NCT05930041).
| S-EPMC11915349 | biostudies-literature
Project description:Accidental bending of the snare sheath occasionally occurs during cold snare polypectomy (CSP). We aimed to demonstrate whether snare bending reduces resection ability and, if it does, what causes this reduction. Using currently available CSP snares and prototype snares, we investigated changes in the resection ability of bent snares as well as the stiffness of their sheaths and wire spindles. Furthermore, to evaluate the performance of the bent snares, we measured the completion rate of CSP for 5-mm-diameter pseudo-lesions on the porcine rectal mucosa. Snare bending significantly decreased resection ability and wire spindle stiffness. Compared with bending the snares once, bending the snares five times further decreased the resection ability and wire spindle stiffness. A strong correlation was observed between wire spindle stiffness and resection ability after snare bending (correlation coefficient = 0.82; P < 0.001). Additionally, snare bending reduced the completion rate of CSP. Bending a CSP snare causes decreased wire spindle stiffness, thereby reducing its resection ability and potentially lowering the resection completion rate. The resection ability cannot be restored; therefore, snare replacement is recommended.
| S-EPMC11681012 | biostudies-literature