Cold Snare Polypectomy
Ontology highlight
ABSTRACT:
DISEASE(S): Colorectal Cancer,Colon Adenoma,Adenoma
PROVIDER: 2271138 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:Colorectal cancer is the second-leading cause of cancer death in the United States. Colorectal cancer screening is recommended to begin at age 50 years for most men and women at average risk for this disease. Colonoscopy is a gold standard method of screening for colorectal cancer, allowing for the detection and removal of colorectal polyps, some of which can progress into malignancy. The literature has shown that the removal of polyps during a colonoscopy results in decreased incidence and mortality related to colorectal cancer. Indeed, the last decade has shown a decline in colorectal cancer incidence and mortality in adults over age 50, largely due to increased colonoscopy screening. Currently, the risk of a patient developing colorectal cancer and thus time intervals for colonoscopy surveillance post-polypectomy is determined by the number, pathology, and size of the polyps that are observed and removed during the colonoscopy procedure. Current surveillance guidelines indicate the need for a shorter interval before the next colonoscopy for patients who have one or more polyps that are 10mm or larger. In addition, different polypectomy techniques are indicated for the treatment of polyps less than 20mm in size. For example, cold forceps may be appropriate for removal of 1mm to 2mm polyps, cold snare for polyps less than 10mm, and hot-snare resection for polyps 10mm to 19mm. Yet, while the number and pathology of polyps are easily obtained and verified, it is standard practice for the size of a polyp to be assessed through endoscopist optical visualization alone, without use of an objective device or standard by which to measure it. Often, the endoscopist will compare the size of the polyp to the size of the snare loop to estimate and document the size of the polyp(s). However, with the size of a polyp being a major indicator of malignant potential as well as an indicator of appropriate polypectomy technique and surveillance intervals, a device with which to take and document accurate and objective measurements of polyps during colonoscopy holds the potential for health benefits. In addition to having a potential clinical benefit for each patient in terms of polypectomy and surveillance intervals, as an objective indicator of polyp size, this technique also holds promise for use in future studies that evaluate polyp size as an indicator of potential malignancy (or future malignancy) and for use by national clinical guidelines committees who may utilize these objective data to update future screening and surveillance recommendations.
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Project description:Interventional Procedure (Arm 1): Snare-WithIn-The-scope-CHannel (SWITCH) Cold Snare Polypectomy
In this arm, all polyps encountered during colonoscopy will be removed by SWITCH cold polypectomy technique. This involved advancement of the snare which is already in the scope channel, transecting the polyp (i.e. polypectomy), then partially withdrawing the snare into the channel (without removing the snare from the scope channel) prior to suctioning the polyp for retrieval. All further polyps encountered in the same patient will be removed by the same technique.
All procedures will be performed by 2 consultant gastroenterologists with expertise in therapeutic colonoscopy. The procedure duration is similar to any standard colonoscopy and is allocated half an hour slot in the weekday elective endoscopy list. Duration can vary depending on number of polyps encountered.
Primary outcome(s): - Mean total polypectomy time per patient
The total polypectomy time is defined as the total time from a polyp has been detected detected by the endoscopist until the polyp has been transected, then has been suctioned and has reached the trap (i.e. from polyp detection until polyp reaching the trap) , as measured by the research assistant with a stop watch. [Assessed from polyp detection until polyp retrieval into the trap. ]
Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy
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