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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2017; 23(2): 328-335
Published online Jan 14, 2017. doi: 10.3748/wjg.v23.i2.328
Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy
Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo
Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
Takaaki Chikugo, Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
Yasutaka Chiba, Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
Author contributions: Komeda Y and Kitano M were involved in the study conception and design; Komeda Y drafted the article and analyzed and interpreted the data; Kashida H and Kudo M performed critical revision of the article for important intellectual content; Tribonias G, Okamoto K, Kono M, Yamada M, Adachi T, Hagiwara S, Matsui S, and Watanabe T collected data; Kashida H, Komeda Y, Sakurai T, Mine H, Nagai T, and Asakuma Y performed endoscopic procedure; Chiba Y performed statistical analysis; Chikugo T conducted pathologic evaluation; all authors performed the final approval of the article.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Kindai University Faculty of Medicine.
Clinical trial registration statement: This study is registered at http://www.umin.ac.jp/ctr/index.htm. The registration identification number is UMIN000015016.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None to declare.
Data sharing statement: The technical appendix, statistical code, and data set are available from the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoriaki Komeda, MD, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. y-komme@mvb.biglobe.ne.jp
Telephone: +81-72-3660221-3525 Fax: +81-72-3672880
Received: August 8, 2016
Peer-review started: August 9, 2016
First decision: September 20, 2016
Revised: October 19, 2016
Accepted: November 13, 2016
Article in press: November 13, 2016
Published online: January 14, 2017
AIM
To compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.
METHODS
This prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely performed.
RESULTS
Two hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).
CONCLUSION
CSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.
Core tip: Cold snare polypectomy (CSP) is more effective in terms of both endoscopic en-bloc resection rate and pathological complete resection rate than hot forceps biopsy (HFB) for resecting diminutive polyps. Moreover, CSP and HFB did not result in any serious adverse events such as delayed bleeding and perforation.
