PMID- 36750222
OWN - NLM
STAT- MEDLINE
DCOM- 20230630
LR  - 20230727
IS  - 1438-8812 (Electronic)
IS  - 0013-726X (Linking)
VI  - 55
IP  - 7
DP  - 2023 Jul
TI  - Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal 
      resection for nonpedunculated colorectal polyps of 10-19 mm: a multicenter 
      observational cohort study.
PG  - 627-635
LID - 10.1055/a-2029-9539 [doi]
AB  - BACKGROUND : Cold snare polypectomy (CSP) is the standard of care for the 
      resection of small (< 10 mm) colonic polyps. Limited data exist for its efficacy 
      for medium-sized (10-19 mm) nonpedunculated polyps, especially conventional 
      adenomas. This study evaluated the effectiveness and safety of CSP/cold 
      endoscopic mucosal resection (C-EMR) for medium-sized nonpedunculated colonic 
      polyps. METHODS : A prospective multicenter observational study was conducted of 
      all morphologically suitable nonpedunculated colonic polyps of 10-19 mm removed 
      by CSP/C-EMR between May 2018 and June 2021. Once resection was complete, 
      multiple biopsies were taken of the margins circumferentially and centrally. The 
      primary outcome was the incomplete resection rate (IRR), based on residual polyp 
      in these biopsy specimens. Secondary outcomes were recurrence rate at first 
      surveillance colonoscopy and rates of adverse events (AEs). RESULTS : CSP/C-EMR 
      was performed for 350 polyps (median size 15 mm; 266 [76.0 %] Paris 0-IIa 
      classification) in 295 patients. Submucosal injection was used for 87.1 % 
      (n = 305) of polyps. Histology showed 68.6 % adenomas, 26.0 % sessile serrated 
      lesions (SSLs) without dysplasia, 4.0 % SSL with dysplasia, and 1.4 % 
      hyperplastic polyps. The IRRs based on margin or central biopsies being positive 
      were 1.7 % (n = 6) and 0.3 % (n = 1), respectively. The polyp recurrence rate was 
      1.7 % (n = 4) at first surveillance colonoscopy - completed for 65.4 % (n = 229) 
      of polyps at a median interval of 9.7 months. AEs occurred in 3.4 % (n = 10) of 
      patients: four with post-polypectomy pain; three self-limiting post-polypectomy 
      bleeds; two post-polypectomy-syndrome-like presentations; and one intraprocedural 
      bleed treated with clips. There were no perforations. CONCLUSION : CSP/C-EMR for 
      morphologically suitable nonpedunculated colonic polyps of 10-19 mm is effective 
      and safe, including for conventional adenomas. Rates of incomplete resection and 
      recurrence were low, with few AEs. Studies directly comparing this method with 
      hot snare resection are required.
CI  - Thieme. All rights reserved.
FAU - Mangira, Dileep
AU  - Mangira D
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
AD  - Department of Medicine, Western Health, Melbourne Medical School, University of 
      Melbourne, Australia.
FAU - Raftopoulos, Spiro
AU  - Raftopoulos S
AD  - Department of Gastroenterology, Peel Health Campus, Perth, Australia.
FAU - Vogrin, Sara
AU  - Vogrin S
AD  - Department of Medicine, Western Health, Melbourne Medical School, University of 
      Melbourne, Australia.
AD  - Australian Institute for Musculoskeletal Science, Melbourne, Australia.
FAU - Hartley, Imogen
AU  - Hartley I
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
FAU - Mack, Alexandra
AU  - Mack A
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
FAU - Gazelakis, Kathryn
AU  - Gazelakis K
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
FAU - Nalankilli, Kumanan
AU  - Nalankilli K
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
FAU - Trinh, Andrew
AU  - Trinh A
AD  - Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.
FAU - Metz, Andrew J
AU  - Metz AJ
AD  - Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia.
FAU - Appleyard, Mark
AU  - Appleyard M
AD  - Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, 
      Australia.
FAU - Grimpen, Florian
AU  - Grimpen F
AD  - Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, 
      Australia.
FAU - Elliott, Timothy
AU  - Elliott T
AD  - Department of Internal Medicine, Ballarat Base Hospital, Ballarat, Australia.
FAU - Brown, Gregor
AU  - Brown G
AD  - Department of Gastroenterology, The Alfred, Melbourne, Australia.
FAU - Moss, Alan
AU  - Moss A
AD  - Department of Gastroenterology, Western Health, Melbourne, Australia.
AD  - Department of Medicine, Western Health, Melbourne Medical School, University of 
      Melbourne, Australia.
LA  - eng
GR  - WHRG2018/Western Health Research Grant/
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20230207
PL  - Germany
TA  - Endoscopy
JT  - Endoscopy
JID - 0215166
SB  - IM
MH  - Humans
MH  - *Colonic Polyps/surgery/pathology
MH  - Colonoscopy/adverse effects/methods
MH  - Prospective Studies
MH  - *Endoscopic Mucosal Resection/adverse effects/methods
MH  - *Adenoma/surgery/pathology
MH  - *Intestinal Polyposis/etiology
MH  - *Colorectal Neoplasms/pathology
COIS- S. Raftopoulos has received lecture fees and research support from Olympus 
      Medical. G. Brown has received research support from Olympus Australia. A. Moss 
      is a consultant for Olympus Australia.D. Mangira, S. Vogrin, I. Hartley, A. Mack, 
      K. Gazelakis, K. Nalankilli, A. Trinh, A.J. Metz, M. Appleyard, F. Grimpen, and 
      T. Elliott declare that they have no conflict of interest.
EDAT- 2023/02/08 06:00
MHDA- 2023/06/30 06:42
CRDT- 2023/02/07 19:23
PHST- 2023/06/30 06:42 [medline]
PHST- 2023/02/08 06:00 [pubmed]
PHST- 2023/02/07 19:23 [entrez]
AID - 10.1055/a-2029-9539 [doi]
PST - ppublish
SO  - Endoscopy. 2023 Jul;55(7):627-635. doi: 10.1055/a-2029-9539. Epub 2023 Feb 7.