Incomplete resection of colorectal polyps of 4-20âmm in size when using a cold snare, and its associated factors.
Endoscopy
; 55(10): 929-937, 2023 10.
Article
em En
| MEDLINE
| ID: mdl-36377124
ABSTRACT
BACKGROUND:
Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as the first-line modality for small (<â10âmm) polyps. This study aimed to evaluate incomplete resection rates (IRRs) when using CSP for colorectal polyps of 4-20âmm.METHODS:
Adults (45-80 years) undergoing screening, surveillance, or diagnostic colonoscopy and CSP by one of nine endoscopists were included. The primary outcome was the IRR for colorectal polyps of 4-20âmm, defined as the presence of polyp tissue in marginal biopsies after resection of serrated polyps or adenomas. Secondary outcomes included the IRR for serrated polyps, ease of resection, and complications.RESULTS:
413 patients were included (mean age 63; 48â% women) and 182 polyps sized 4-20âmm were detected and removed by CSP. CSP required conversion to hot snare resection in <â1â% of polyps of <â10âmm and 44â% of polyps sized 10-20âmm. The IRRs for polyps <â10âmm and ≥â10âmm were 18â% and 21â%. The IRR was higher for serrated polyps (26â%) compared with adenomas (16â%). The IRR was higher for flat (IIa) polyps (odds ratio [OR] 2.9, 95â%CI 1.1-7.4); and when resection was judged as difficult (OR 4.2, 95â%CI 1.5-12.1), piecemeal resection was performed (OR 6.6, 95â%CI 2.0-22.0), or visible residual polyp was present after the initial resection (OR 5.4, 95â%CI 2.0-14.9). Polyp location, use of a dedicated cold snare, and submucosal injection were not associated with incomplete resection. Intraprocedural bleeding requiring endoscopic intervention occurred in 4.7â%.CONCLUSIONS:
CSP for polyps of 4-9âmm is safe and feasible; however, for lesions ≥â10âmm, CSP failure occurs frequently, and the IRR remains high even after technical success. Incomplete resection was associated with flat polyps, visual residual polyp, piecemeal resection, and difficult polypectomies.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
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Adenoma
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Pólipos do Colo
Tipo de estudo:
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article