Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2021; 27(47): 8182-8193
Published online Dec 21, 2021. doi: 10.3748/wjg.v27.i47.8182
Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching
Masashi Saito, Takeshi Yamamura, Masanao Nakamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Yasuyuki Mizutani, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Hiroki Kawashima, Masatoshi Ishigami, Mitsuhiro Fujishiro
Masashi Saito, Takeshi Yamamura, Masanao Nakamura, Eri Ishikawa, Yasuyuki Mizutani, Takuya Ishikawa, Naomi Kakushima, Kazuhiro Furukawa, Eizaburo Ohno, Masatoshi Ishigami, Mitsuhiro Fujishiro, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
Keiko Maeda, Tsunaki Sawada, Hiroki Kawashima, Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
Author contributions: Saito M and Yamamura T were the guarantors and designed the study; Saito M, Yamamura T, Nakamura M, Kawashima H, and Ishikawa T participated in the acquisition, analysis, and interpretation of the data; Saito M drafted the initial manuscript; Ohno E, Yamamura T, Maeda K, Sawada T, Ishikawa E, Mizutani Y, Kakushima N, and Furukawa K revised the article critically for important intellectual content; Yamamura T and Nakamura M contributed to statistical analysis; Fujishiro M made final approval of the article; all authors have read and approved the final manuscript.
Institutional review board statement: This real-world retrospective study was approved by the Ethical Review Board of the Nagoya University Hospital (2015-0449).
Informed consent statement: Informed consent was obtained in the form of opt-out on the website.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takeshi Yamamura, MD, PhD, Assistant Professor, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 4668550, Japan. tyamamu@med.nagoya-u.ac.jp
Received: June 17, 2021
Peer-review started: June 17, 2021
First decision: July 2, 2021
Revised: July 15, 2021
Accepted: December 7, 2021
Article in press: December 7, 2021
Published online: December 21, 2021
Processing time: 182 Days and 18 Hours
Abstract
BACKGROUND

Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice.

AIM

To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching.

METHODS

We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.

RESULTS

After propensity score matching, there were no significant differences in the patients’ and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group (P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference (P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group.

CONCLUSION

Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.

Keywords: Cold polypectomy, Colorectal polyp, Hot polypectomy, Local recurrence, Safety, Propensity score matching

Core Tip: In this study, the recurrence rate after cold polypectomy (CP) was evaluated with colonoscopy at long intervals in real clinical practice for non-pedunculated colorectal polyps smaller than 10 mm, and compared with hot polypectomy (HP). Although it is a retrospective study, we used propensity score matching to correct the bias of both groups and compared them. The recurrence rates of both procedures were similar, and it was considered that CP, which is easier in clinical practice, is more useful for small polyps than HP.