ORLANDO – Cold snare polypectomy is clearly superior to double biopsy cold forceps polypectomy for the complete removal of small colorectal polyps, according to findings from a single-center, prospective, randomized controlled study involving 54 patients.
The rates of both visual polyp eradication and complete histologic eradication were significantly higher in patients randomized to the cold snare polypectomy (CSP) group than in those randomized to the cold forceps polypectomy (CFP) group (91.5% vs. 78.3%, and 93.2% vs. 75.9%, respectively), Dr. Chang Kyun Lee reported at the annual Digestive Disease Week.
Additional analysis in the CFP group showed a histologic eradication rate of 92% for 1- to 3-mm polyps, and 50% for 4- to 5-mm polyps.
On logistic regression analysis, CFP and polyp size of 4 mm or larger were associated with incomplete polyp eradication (odds ratios 4.75 and 4.38, respectively), whereas lesion location and histologic diagnosis were not, said Dr. Lee of Kyung Hee University, Seoul, Republic of Korea.
The 54 study subjects were adults (mean age, 53.7 years) and a total of 115 1- to 5-mm polyps. Most polyps (88%) were 0-IIa type, and most (70.1%) were tubular adenomas. The mean polyp size was 3.66 mm.
The treatment groups did not differ significantly with respect to sex, age, indication for colonoscopy, or procedure time, and no differences were noted in the size, location, and diagnosis of polyps.
Only one polyp with advanced histologic features was identified. The 5-mm lesion – a tubular adenoma – was located in the proximal colon and was removed completely via CFP.
CSP was performed using a minisnare, and CFP was performed using standard large-capacity forceps and a double biopsy technique (two "bites" per forceps pass). Polyp removal time was significantly shorter with CSP than with CFP (14.29 vs. 22.03 seconds), though this difference was not clinically meaningful. The rate of successful retrieval of polypectomy samples was lower in the CSP group (93.2% vs. 100% for CFP), Dr. Lee noted.
While cold techniques are widely used in clinical practice, few studies have directly compared outcomes with different techniques. These findings indicate that choice of technique is clinically important to the endoscopic removal of diminutive polyps, he said.
"Based on the findings, we recommend that cold snaring be considered as the primary method for endoscopic treatment of polyps in the 4- to 5-mm size range. However, given the incomplete polypectomy rate in this study – about 15% – further technical refinements and instrumental innovations are required for future studies," Dr. Lee concluded.
Dr. Lee reported having no disclosures.
