Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps

Hyun Soo Kim, Ho Yeon Jung, Hong Jun Park, Hee Man Kim, Jae Ho Seong, Yong Seok Kang, Mee Yon Cho, Min Heui Yu, Dae Ryong Kang

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Aims: The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps. Methods: Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8% higher than that of the HSP group. Results: A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4 × 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polyp size was 6.3 ± 1.3 mm. The complete resection rate did not differ between the HSP and EMR groups (88.4% [152/172] vs 92.8% [168/181], respectively; P =.2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2% vs 0.6%, respectively; P =.009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95% confidence interval, 1.03-7.75; P =.044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection. Conclusion: EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist's preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.)

Original languageEnglish
Pages (from-to)1539-1547
Number of pages9
JournalGastrointestinal Endoscopy
Volume87
Issue number6
DOIs
Publication statusPublished - 2018 Jun

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Polyps
Sodium Chloride
Epinephrine
Pathology
Hemorrhage
Adenomatous Polyps
Random Allocation
Surgical Instruments
Adenoma
Sample Size
Logistic Models
Odds Ratio
Regression Analysis
Clinical Trials
Confidence Intervals
Biopsy
Safety

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Kim, Hyun Soo ; Jung, Ho Yeon ; Park, Hong Jun ; Kim, Hee Man ; Seong, Jae Ho ; Kang, Yong Seok ; Cho, Mee Yon ; Yu, Min Heui ; Kang, Dae Ryong. / Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps. In: Gastrointestinal Endoscopy. 2018 ; Vol. 87, No. 6. pp. 1539-1547.
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abstract = "Background and Aims: The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps. Methods: Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8{\%} higher than that of the HSP group. Results: A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4 × 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polyp size was 6.3 ± 1.3 mm. The complete resection rate did not differ between the HSP and EMR groups (88.4{\%} [152/172] vs 92.8{\%} [168/181], respectively; P =.2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2{\%} vs 0.6{\%}, respectively; P =.009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95{\%} confidence interval, 1.03-7.75; P =.044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection. Conclusion: EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist's preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.)",
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Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps. / Kim, Hyun Soo; Jung, Ho Yeon; Park, Hong Jun; Kim, Hee Man; Seong, Jae Ho; Kang, Yong Seok; Cho, Mee Yon; Yu, Min Heui; Kang, Dae Ryong.

In: Gastrointestinal Endoscopy, Vol. 87, No. 6, 06.2018, p. 1539-1547.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hot snare polypectomy with or without saline solution/epinephrine lift for the complete resection of small colorectal polyps

AU - Kim, Hyun Soo

AU - Jung, Ho Yeon

AU - Park, Hong Jun

AU - Kim, Hee Man

AU - Seong, Jae Ho

AU - Kang, Yong Seok

AU - Cho, Mee Yon

AU - Yu, Min Heui

AU - Kang, Dae Ryong

PY - 2018/6

Y1 - 2018/6

N2 - Background and Aims: The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps. Methods: Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8% higher than that of the HSP group. Results: A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4 × 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polyp size was 6.3 ± 1.3 mm. The complete resection rate did not differ between the HSP and EMR groups (88.4% [152/172] vs 92.8% [168/181], respectively; P =.2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2% vs 0.6%, respectively; P =.009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95% confidence interval, 1.03-7.75; P =.044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection. Conclusion: EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist's preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.)

AB - Background and Aims: The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps. Methods: Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8% higher than that of the HSP group. Results: A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4 × 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polyp size was 6.3 ± 1.3 mm. The complete resection rate did not differ between the HSP and EMR groups (88.4% [152/172] vs 92.8% [168/181], respectively; P =.2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2% vs 0.6%, respectively; P =.009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95% confidence interval, 1.03-7.75; P =.044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection. Conclusion: EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist's preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.)

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