Mo1648 PRACTICE PATTERNS OF POLYPECTOMY TECHNIQUES FOR THE RESECTION OF POLYPS BASED ON SIZE, MORPHOLOGY AND LOCATION - RESULTS FROM A MULTICENTER TRIAL.

Abstract

Conventionally, resection with cold forceps and cold snare have been preferred for sub-centimeter polyps, whereas hot snare has been used for larger polyps. We examined the practice patterns and trends in methods of polyp resection as part of a large multi-center randomized control trial (RCT) focused on adenoma detection rates. Average risk patients presenting for screening and surveillance colonoscopies were prospectively enrolled in this trial evaluating ADR. The morphology, size and location of colon polyps were collected. Polyps were resected using cold forceps, cold snare (CSP), hot snare (HSP) or EMR. Based on the size, the polyps were divided into 1-9mm, 10-19mm and ≥ 20 mm. We compared the use of cold snare and hot snare use based on polyp location (right versus left colon), size (1-9mm, 10-19mm, >20mm) and polyp morphology based on Paris classification. Continuous variables were compared using one way analysis of variance, categorical variables compared using chi-square test. Of 810 patients enrolled thus far, (mean age 61.50 ± 9.33 years, 74% males) a total of 1808 polyps were resected during either screening (40%) or surveillance (60%) colonoscopy. A total of 1650 (91%) polyps found were 1-9mm, 126(7%) were 10-19mm and 25(1.3%) were >20mm. Overall, cold snare polypectomy (CSP) was used in 68% of polypectomies (1215/1808). Based on the polyp size, CSP was used in 70% of 1-9mm polyps, and 41% in polyps sized 10-19mm. Hot snare polypectomy (HSP) was used in 7% of total polypectomies (127/1808), including all (100%) resected polyps >20mm and 64 (51%) polyps 10-19mm. CSP and HSP usage was not statistically significant based on polyp location (right colon: 66.9% vs 70.3%) (left colon: 5.8% vs 10.1%) respectively. HSP was used for all > 20 mm polyps, and for 61.4% of all pedunculated polyps (Paris type 1p). For 10-19 mm polyps, there was no significant difference between CSP and HSP (overall 40.8 % vs 51.2%), or based on location (42.5% vs 46% for right colon and 36.8% vs 63.2% for left colon, p-value=0.106) or based on Paris classification for sessile polyps (Paris type Is and IIa) – 43% vs 48% (p=0.182) The majority (90%) of polyps detected during average risk screening/surveillance colonoscopy are 1-9 mm in size. Cold snare polypectomy is the resection method of choice for polyps < 10 mm, whereas hot snare is preferred for the resection of all large (≥20mm) and majority of the pedunculated polyps. For 10-19 mm polyps, there was no difference between the use of cold snare or hot snare polypectomy based either on polyp location or morphology (Paris Is and IIa).