Tu1502 Polypectomy Using Jumbo Biopsy Forceps for Small Colorectal Polyps: a Multi-Center Prospective Trial

Abstract

Polypectomy Using Jumbo Biopsy Forceps for Small Colorectal Polyps: a Multi-Center Prospective Trial Toshio Uraoka*, Takahisa Matsuda, Yasushi Sano, Yutaka Saito, Makoto Kobayashi, Taku Sakamoto, Mineo Iwatate, Keisuke Hori, Naohisa Yahagi, Takahiro Fujii Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology, Sano Hospital, Kobe, Japan; Department of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Japan; Department of Endoscopy, Okayama University Hospital, Okayama, Japan; TF Clinic, Tokyo, Japan Background and Aim: Colonoscopy with polypectomy can reduce colorectal cancer incidence and mortality. Various polypectomy techniques are now in use with the application of each determined by a number of factors including polyp characteristics, patient background and the endoscopist’s experience and skill. Cold polypectomy with biopsy forceps can remove small polyps quite easily and avoid electrocautery-associated complications. The objective of the technique is to remove all visible residual tissue with the fewest number of bites. The aim of this multicenter prospective study was to evaluate the efficacy of jumbo biopsy forceps designed with a greater capacity for removing larger tissue samples. Method: Patients with endoscopically identified adenomatous polyps 5mm, who underwent colonoscopies performed by 22 participating endoscopists with varying levels of skill from four endoscopic units, were enrolled consecutively. Patients receiving antiplatelet drugs or warfarin were included in this study, but such medications were no longer being administered prior to the procedures. Polyp size was measured with open biopsy forceps. Lesions were then treated with the intention of removing all polyp tissue with one forceps bite using Radial Jaw 4 jumbo forceps (Boston Scientific, Natick, MA) which has a jaw volume of 12.4mm3 compared to 5.3mm3 for Radial Jaw 4 standard forceps. Complete polyp removal was determined by an independent observer using narrow-band imaging with magnification after rinsing with water. If residual polyp tissue was detected, additional bites were made with the same forceps until complete removal was achieved at the polypectomy site. Measurement of bleeding time after the final bite was recorded with histopathological analysis performed on every lesion. The primary endpoint was the rate of one-bite polypectomy for polyps 5mm using the jumbo biopsy forceps. Results: A total of 223 polyps were removed from 127 patients. Mean polyp size was 3.3 0.9mm and the average number of bites required for complete removal was 1.09 0.35. The rate of one-bite polypectomy was 85% (204/223) and included 100%, 100%, 96%, 88% and 70% for lesions 1mm, 2mm, 3mm, 4mm and 5mm in diameter, respectively (p 0.0001). There were no significant differences in the one-bite rate based on macroscopic type (flat 91.6% vs. polypoid 91.3%, p 0.96) or the endoscopists’ experience (p 0.36). Histopathology revealed 185 adenomas and 38 nonadenomatous polyps. None of the cases required more than three minutes to stop any bleeding and there were no adverse complications such as postpolypectomy bleeding or perforation. Conclusion: This study demonstrated polypectomy using jumbo biopsy forceps was a simple and safe technique, but a randomized controlled multicenter trial should be conducted to fully evaluate its efficacy for the polypectomy of small colorectal polyps.