Background and Aims
A previous study reported that cold snare polypectomy (CSP) was superior to cold forceps
polypectomy (CFP) for the removal of diminutive colorectal polyps (DCPs) (≤5 mm) when
the techniques were assessed for completeness of resection. However, completeness
is expected to be greater with CFP when strict investigation of the remnant polyp
is performed. The aim of this study was to assess the efficacy of CFP with narrow-band
imaging (NBI) evaluation of polypectomy sites for removal of DCPs, compared with CSP.
Methods
This was a randomized, controlled, noninferiority trial at a tertiary-care referral
hospital. Of the 380 patients screened, 146 patients with 231 DCPs were enrolled.
CFP was used to resect DCPs until no remnant polyp was visible by NBI endoscopy. The
primary noninferiority endpoint was histologic eradication of polyps, with a noninferiority
margin of -10%.
Results
A size of >3 mm was seen in 129 polyps (55.8%). The overall rates of histologic eradication
were 90.5% in the CFP group and 93.0% in the CSP group (difference, 2.5%; 95% confidence
interval [CI], -9.67 to 4.62). However, when confined to the polyps >3 mm, the histologic
eradication rate was 86.8% and 93.4% (95% CI, -17.2 to 3.6), respectively. Polyp size,
histology, location, and time taken for polypectomy did not differ between the groups.
The failure rate of tissue retrieval was higher in the CSP than in the CFP group (7.8%
vs 0.0%, respectively; P =.001).
Conclusions
In this study, >90% of all DCPs were completely resected by using CFP with NBI evaluation
of polypectomy sites, showing noninferiority compared with CSP. However, in polyps
measuring >3 mm, CFP failed to show noninferiority versus CSP. CFP appears to be the
proper method for resection of DCPs 1 to 3 mm in size if no remnant polyp is visible
by NBI endoscopy, but CFP is likely to be insufficient for larger polyps. (Clinical
trial registration number: NCT02201147.)
Abbreviations:
CFP (cold forceps polypectomy), CSP (cold snare polypectomy), DCP (diminutive colorectal polyp), NBI (narrow-band imaging)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2015
Accepted:
August 19,
2015
Received:
May 2,
2015
Footnotes
DISCLOSURE: This work was supported, in part, by the SoonChunHyang University Research Fund. All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Ko at [email protected]
See CME section; p. 637.
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
