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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Hot snare polypectomy vs endoscopic mucosal resection using bipolar snare for intermediate size colorectal lesions: Propensity score matching
Nobuhisa Minakata, Tatsuro Murano, Masashi Wakabayashi, Maasa Sasabe, Takashi Watanabe, Tomohiro Mitsui, Hiroki Yamashita, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tomohiro Kadota, Kensuke Shinmura, Hiroaki Ikematsu, Tomonori Yano
Nobuhisa Minakata, Tatsuro Murano, Maasa Sasabe, Takashi Watanabe, Tomohiro Mitsui, Hiroki Yamashita, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tomohiro Kadota, Kensuke Shinmura, Hiroaki Ikematsu, Tomonori Yano, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa 2778577, Chiba, Japan
Masashi Wakabayashi, Department of Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa 2778577, Chiba, Japan
Author contributions: Minakata N, Murano T and Ikematsu H contributed to conceptualization; Minakata N and Murano T contributed to methodology; Minakata N and Wakabayashi M contributed to statistical analysis; Minakata N and Murano T contributed to writing - original draft preparation; Wakabayashi M, Sasabe M, Watanabe T, Mitsui T, Yamashita H, Inaba A, Sunakawa H, Nakajo K, Kadota T, Shinmura K, Ikematsu H, and Yano T contributed to writing - review and editing.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of our hospital, No. 2017-434.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting this study’s findings are available from the corresponding author, Murano T, upon reasonable request at tatmuran@east.ncc.go.jp.
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: Tatsuro Murano, MD, PhD, Doctor, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa 2778577, Chiba, Japan. tatmuran@east.ncc.go.jp
Received: March 2, 2023
Peer-review started: March 2, 2023
First decision: April 8, 2023
Revised: April 21, 2023
Accepted: May 23, 2023
Article in press: May 23, 2023
Published online: June 21, 2023
Processing time: 105 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
Research background
In endoscopic resection (ER) of colorectal lesions, it is important to develop resection methods that enable efficient and safe resection. Most recently, we have reported in ex vivo porcine model that endoscopic resection using bipolar snare for intermediate size lesions didn’t lead to thermal injury for the intrinsic muscle layer even without submucosal injection. Therefore, the bipolar ER for intermediate size colorectal lesions of 10-15 mm has the potential to provide prominent outcomes in an efficient and highly safe manner even without submucosal injection.
Research motivation
We would like to assess the treatment outcomes of the bipolar resection with and without submucosal injection.
Research objectives
The present study aims to compare the resection results of endoscopic mucosal resection (EMR), which refers to the resection following submucosal injection, and hot snare polypectomy (HSP), which refers to the resection with no submucosal injection, to evaluate the efficacy and safety of HSP with bipolar snare for 10-15 mm lesions.
Research methods
We conducted the single-centre retrospective analysis of all 10-15 mm size colorectal lesions with a diagnosis of JNET Type 2A and resected by either EMR or HSP from January 2018 to June 2021. The target lesions were divided into two groups, HSP group and EMR group, and treatment outcomes and the adverse events were compared by conducting propensity score matching analysis.
Research results
Of the 565 lesions in 463 patients, 117 lesions each in the HSP and EMR groups were selected after propensity score matching. In the original cohort, there was a significant difference in antithrombotic drug use (P < 0.05), lesion size (P < 0.01), location (P < 0.01), and macroscopic type (P < 0.05) between the HSP and EMR groups. In the matched cohort, the en bloc resection rates were 93.2% (109/117) in the HSP group and 92.3% (108/117) in the EMR group, in which there was no significant difference (P = 0.81). Moreover, no significant difference was observed in the R0 resection rate [77.8% (91/117) vs 80.3% (94/117), P = 0.64]. The rates of delayed bleeding were comparable between the groups [1.7% (2/117)]. Perforation occurred in the EMR group [0.9% (1/117)] but not in the HSP group.
Research conclusions
Using bipolar snare, ER of nonpedunculated 10–15 mm colorectal lesions may be performed safely and effectively, even without submucosal injection.
Research perspectives
A large-cohort, multicentre, prospective, randomized controlled trial is warranted to prove the non-inferiority of bipolar HSP to bipolar EMR in treatment outcomes with ER of nonpedunculated 10–15 mm colorectal lesions.
