Mo1631 A PILOT RANDOMIZED TRIAL OF POLYPECTOMY TECHNIQUES FOR 4-6 MM COLONIC POLYPS

Abstract

There is wide variation in use of polypectomy techniques among endoscopists for resection of 4-6mm polyps. We evaluated the various polypectomy techniques in terms of risk of recurrent adenoma, efficiency and adverse events. The study was a randomized controlled trial, conducted at three endoscopy units at a single institution. Outpatients between the ages of 18-75 years with one or more 4-6 mm polyps were randomized to one of the three polypectomy techniques: cold forceps (CF), cold snare (CS) and hot snare (HS). Patients on long term anti-coagulation and history for inflammatory bowel disease were excluded. Polyp size, location and morphology were recorded as well as polypectomy duration in seconds (s). Each study polypectomy site was tattooed. Adequacy of polypectomy was determined by visual absence of recurrent adenoma tissue on surveillance exam. A total of 353 patients were randomized to one of the three polypectomy techniques. Ninety three patients (26.4%) were excluded post randomization (Figure 1); 260 completed the initial colonoscopy, mean age 57 +/- 6.6 years, 50.4% women). Ninety-one, 87 and 82 patients were randomized to CF, CS and HS polypectomy, respectively (Figure 1). A total of 316 study polyps were identified. Mean (SD) time for polyp resection for CF, CS, and HS were 198.8 s (SD 159.5), 58.5 s (SD 79.6), and 96.8 s (SD 54.6), respectively. CS and HS required less time than CF (P <0.001). From the 260 participants randomized, 96 (36.9%) did not complete the surveillance colonoscopy. Among those who completed surveillance, the number of definite recurrences was 9 with CF, 7 with CS and 1 with HS. The recurrence rate with CF and CS polypectomy was 2.07 (95% CI 0.93-8.54; P=0.32) and 1.69 (95% CI 0.40-9.00; P=0.48) times higher than with HS, respectively, however, neither result was statistically significant. From 260 procedures, there were 6 complications (2.3%): 4 with HS (2 post cautery syndrome, 2 delayed bleeding), 1 with CS (immediate bleeding) and one with CF (immediate bleeding). Three required hospitalization, 3 underwent repeat colonoscopy, 2 had clip placement, 1 had bipolar cautery and 1 required blood transfusion. For polypectomy of 4-6 mm polyps, CS and HS polypectomy require less time than CF. HS polypectomy may have a lower risk for recurrent neoplasia at the polypectomy site, but a larger trial with more complete follow up (i.e. surveillance colonoscopy) is required. High attrition rate is a significant challenge in conducting randomized controlled trials with polyp recurrence as an endpoint.