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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(05): E480-E489
DOI: 10.1055/a-2029-2392
Original article

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Leslie Motchum
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
2   Faculty of Medicine of Montreal University, Montreal, Canada
,
Roupen Djinbachian
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Elham Rahme
4   Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Canada
5   Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
,
Mahsa Taghiakbari
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
2   Faculty of Medicine of Montreal University, Montreal, Canada
,
Simon Bouchard
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Mickaël Bouin
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Sacha Sidani
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Érik Deslandres
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
,
Mark Takla
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
2   Faculty of Medicine of Montreal University, Montreal, Canada
,
Nissim Max Frija-Gruman
6   Faculty of Medicine and Health Sciences of Sherbrooke, Sherbrooke, Canada
,
Alan Barkun
7   Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
8   Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, Canada
,
Daniel von Renteln
1   Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
3   Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
› Author Affiliationshttp://dx.doi.org/10.13039/100008497

TRIAL REGISTRATION: Prospective single-center study NCT04548947 at ClinicalTrials.gov
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Abstract

Background and study aims Incomplete resection of 4- to 20-mm colorectal polyps occur frequently (> 10 %), putting patients at risk for post-colonoscopy colorectal cancer. We hypothesized that routine use of wide-field cold snare resection with submucosal injection (CSP-SI) might reduce incomplete resection rates (IRRs).

Patients and methods Patients aged 45 to 80 years undergoing elective colonoscopies were enrolled in a prospective clinical study. All 4- to 20-mm non-pedunculated polyps were resected using CSP-SI. Post-polypectomy margin biopsies were obtained to determine IRRs through histopathology assessment. The primary outcome was IRR, defined as remnant polyp tissue found on margin biopsies. Secondary outcomes included technical success and complication rates.

Results A total of 429 patients (median age 65 years, 47.1 % female, adenoma detection rate 40 %) with 204 non-pedunculated colorectal polyps 4 to 20 mm removed using CSP-SI were included in the final analysis. CSP-SI was technical successful in 97.5 % (199/204) of cases (5 conversion to hot snare polypectomy). IRR for CSP-SI was 3.8 % (7/183) (95 % confidence interval [CI] 2.7 %-5.5 %). IRR was 1.6 % (2/129), 16 % (4/25), and 3.4 % (1/29) for adenomas, serrated lesions, and hyperplastic polyps respectively. IRR was 2.3 % (2/87), 6.3 % (4/64), 4.0 % (6/151), and 3.1 % (1/32) for polyps 4 to 5 mm, 6 to 9 mm, < 10 mm, and 10 to 20 mm, respectively. There were no CSP-SI-related serious adverse events.

Conclusions Use of CSP-SI results in lower IRRs compared to what has previously been reported in the literature for hot or cold snare polypectomy when not using wide-field cold snare resection with submucosal injection. CSP-SI showed an excellent safety and efficacy profile, however comparative studies to CSP without SI are required to confirm these results.



Publication History

Received: 16 August 2022

Accepted after revision: 31 January 2023

Accepted Manuscript online:
06 February 2023

Article published online:
17 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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