Abstract
BackgroundFactors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP.MethodsWe retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists’ experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses.ResultsIn total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018).ConclusionsA higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.
Highlights
Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists’ experience, we revealed the predictive factors associated with R0 resection and immediate post-cold snare polypectomy (CSP) bleeding by univariate and multivariate analyses
Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection
A higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging
Summary
Colorectal cancer (CRC) is a fatal cancer that ranks fourth around the world, and second in Japan, in mortality among all malignant disorders.[1,2] Colonoscopy is associated with a reduced incidence and mortality of CRC, and endoscopic polypectomy at the time of colonoscopy has become effective in interrupting the progression of the adenoma-carcinoma sequence, preventing death from CRC.[3,4,5,6]As for endoscopic polypectomy, a R0 resection of polyps should be performed, since incomplete resection is considered to account for 19% to 30.8% of interval CRC.[7,8,9] In addition, polypectomy carries a definite risk of complications, such as bleeding or perforation. [3,10] it is desirable for the therapeutic procedure of polypectomy to provide the high R0 resection rate and safety.Previous studies have revealed that most polypectomies are performed for subcentimetric (< 10 mm) lesions, which represent over 80% of all polyps, and recently, the high efficacy and safety of cold polypectomy without electrocautery current for subcentimetric polyps has been reported.[11]. As for endoscopic polypectomy, a R0 resection of polyps should be performed, since incomplete resection is considered to account for 19% to 30.8% of interval CRC.[7,8,9] In addition, polypectomy carries a definite risk of complications, such as bleeding or perforation. CSP has been determined to be superior to CFP in the R0 resection rate of small colorectal polyps.[12,13] there are few complications, such as delayed bleeding or perforation, after CSP.[11,14,15,16] CSP is a safe and reliable technique for the treatment of diminutive and small colorectal polyps. Factors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP
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