Hot snare polypectomy vs endoscopic mucosal resection using bipolar snare for intermediate size colorectal lesions: Propensity score matching

doi:10.3748/wjg.v29.i23.3668

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World Journal of Gastroenterology

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1007-9327

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Retrospective Study

World J Gastroenterol. Jun 21, 2023; 29(23): 3668-3677
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3668

Table 1 Patient and lesion characteristics

	Original cohort				Propensity score-matched cohort
	HSP	EMR	P value	Standardized difference	HSP	EMR	P value	Standardized difference
No. of lesions	440	125			117	117
Age (yr), mean ± SD (range)	69.7 ± 9.47 (36–90)	69.8 ± 8.36 (46–89)	0.53	0.013	69.5 ± 8.34 (43–85)	70.1 ± 8.78 (46–89)	0.67	0.072
Sex, n (%)			0.83	0.022			1.00	0
Male	328 (74.6)	92 (73.6)			87 (74.4)	87 (74.4)
Female	112 (25.5)	33 (26.4)			30 (25.6)	30 (25.6)
Antithrombotic drugs use, n (%)			0.031	0.21			0.87	0.021
Yes	66 (15.0)	29 (23.2)			25 (21.4)	26 (22.2)
No	374 (85.0)	96 (76.8)			92 (78.6)	91 (77.8)
Size (mm), mean ± SD (range)	11.2 ± 1.76 (10–15)	12.7 ± 2.02 (10–15)	< 0.01	0.77	12.4 ± 2.08 (10–15)	12.5 ± 2.01 (10–15)	0.72	0.054
Location, n (%)			< 0.01	0.38			0.94	0.054
Right-sided colon	240 (54.6)	63 (50.4)			61 (52.1)	63 (53.9)
Left-sided colon	155 (35.2)	36 (28.8)			32 (27.4)	32 (27.4)
Rectum	45 (10.2)	26 (20.8)			24 (20.5)	22 (18.8)
Histological findings, n (%)			0.087	0.26			0.081	0.23
SSL	5 (1.1)	0 (0)			3 (2.6)	0 (0)
LGD/HGD	434 (98.6)	123 (98.4)			114 (97.4)	117 (100)
T1a/T1b	1 (0.2)	2 (1.6)			0 (0)	0 (0)
Macroscopic type, n (%)			0.011	0.3			0.79	0.034
Type 0–Is, 0–Isp	176 (40.0)	66 (52.8)			62 (53.0)	60 (51.3)
Type 0–IIa	264 (60.0)	59 (47.2)			55 (47.0)	57 (48.7)
Endoscopist, n (%)			0.053	0.2			0.51	0.086
Expert	186 (42.3)	65 (52.0)			63 (53.9)	58 (49.6)
Non-expert	254 (57.7)	60 (48.0)			54 (46.2)	59 (50.4)

HSP: Hot snare polypectomy; EMR: Endoscopic mucosal resection; right-sided colon: Caecum to transverse colon; left-sided colon: Descending colon to sigmoid colon; SSL: Sessile serrated lesion; LGD: Low-grade dysplasia; HGD: High-grade dysplasia; T1a: Shallow submucosal invasive cancer; T1b: Deep submucosal invasive cancer; SD: Standard deviation.

Table 2 Comparison of outcomes between the hot snare polypectomy and endoscopic mucosal resection groups

	Original cohort			Propensity score-matched cohort
	HSP	EMR	P value	HSP	EMR	P value
No. of lesions	440	125		117	117
En bloc resection, n, % (95%CI)	417, 94.8 (92.3-96.7)	116, 92.8 (86.8-96.7)	0.4	109, 93.2 (87.0-97.0)	108, 92.3 (85.9-96.4)	0.81
Piecemeal resection, n, % (95%CI)	23, 5.2 (3.3-7.7)	9, 7.2 (3.3-13.2)		8, 6.8 (3.0-13.0)	9, 7.7 (3.6-14.1)
R0 resection, n, % (95%CI)	359, 81.6 (77.6-85.1)	101, 80.8 (72.8-87.3)	0.84	91, 77.8 (69.2-84.9)	94, 80.3 (72.0-87.1)	0.64
RX/R1 resection, n, % (95%CI)	81, 18.4 (14.9-22.4)	24, 19.2 (12.7-27.2)		26, 22.2 (15.1-30.8)	23, 19.7 (12.9-28.0)
Delayed bleeding, n, % (95%CI)	5, 1.1 (0.4-2.6)	2, 1.6 (0.2-5.7)	0.68	2, 1.7 (0.2-6.0)	2, 1.7 (0.2-6.0)	1.00
Perforation, n, % (95%CI)	0, 0 (0-0.8)	1, 0.8 (0.0-4.4)	0.06	0, 0 (0-3.1)	1, 0.9 (0-4.7)	N/A

HSP: Hot snare polypectomy; EMR: Endoscopic mucosal resection; R0: Negative margin both horizontally and vertically; RX: Unclear resection margin either horizontally or vertically; R1: Positive resection margin either horizontally or vertically; CI: Confidence interval; N/A: Not applicable.

Table 3 Comparison of negative margin both horizontally and vertically resection rates between the hot snare polypectomy group and endoscopic mucosal resection groups

	*R0 resection rate, %, n/n* (95%CI)**
	HSP	EMR	P value
Total	77.8, 91/117 (69.2-84.9)	80.3, 94/117 (72.0-87.1)
Size
10–12 mm	77.9, 53/68 (66.2-87.1)	82.9, 58/70 (72.0-90.8)	0.52
13–15 mm	77.6, 38/49 (63.4-88.2)	76.6, 36/47 (62.0-87.7)	1.00
Macroscopic type
Type 0-Is, 0-Isp	77.4, 48/62 (65.0-87.1)	86.7, 52/60 (75.4-94.1)	0.24
Type 0-IIa	78.2, 43/55 (65.0-88.2)	73.7, 42/57 (60.3-84.5)	0.66
Location
Right-sided colon	75.4, 46/61 (62.7-85.5)	74.6, 47/63 (62.1-84.7)	1.00
Left-sided colon	84.4, 27/32 (67.2-94.7)	78.1, 25/32 (60.0-90.7)	0.75
Rectum	75.0, 18/24 (53.3-90.2)	100, 22/22 (84.6-100)	0.022
Endoscopist
Expert	81.0, 51/63 (69.1-89.8)	82.8, 48/58 (70.6-91.4)	0.82
Non-expert	74.1, 40/54 (60.3-85.0)	78.0, 46/59 (65.3-87.7)	0.66

HSP: Hot snare polypectomy; EMR: Endoscopic mucosal resection; R0: Negative margin both horizontally and vertically.

Citation: Minakata N, Murano T, Wakabayashi M, Sasabe M, Watanabe T, Mitsui T, Yamashita H, Inaba A, Sunakawa H, Nakajo K, Kadota T, Shinmura K, Ikematsu H, Yano T. Hot snare polypectomy vs endoscopic mucosal resection using bipolar snare for intermediate size colorectal lesions: Propensity score matching. World J Gastroenterol 2023; 29(23): 3668-3677
URL: https://www.wjgnet.com/1007-9327/full/v29/i23/3668.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i23.3668