Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4–9 mm: a randomized controlled trial

Ina B. Pedersen; Anna Rawa-Golebiewska; Audrey H. Calderwood; Lone D. Brix; Louise B. Grode; Edoardo Botteri; Marek Bugajski; Michal F. Kaminski; Wladyslaw Januszewicz; Hjalmar Ødegaard; Britta Kleist; Mette Kalager; Magnus Løberg; Michael Bretthauer; Geir Hoff; Asle Medhus; Øyvind Holme

doi:10.1055/a-1734-7952

Endoscopy, Inhaltsverzeichnis

Endoscopy 2022; 54(10): 961-969
DOI: 10.1055/a-1734-7952

Original article

Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4–9 mm: a randomized controlled trial

Ina B. Pedersen

¹Department of Medicine, Sørlandet Hospital, Kristiansand, Norway

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

,

Anna Rawa-Golebiewska

³Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

,

Audrey H. Calderwood

⁴Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

,

Lone D. Brix

⁵Department of Anesthesiology, Surgery and Intensive Care, Horsens Regional Hospital, Horsens, Denmark

,

Louise B. Grode

⁶Department of Medicine, Horsens Regional Hospital, Horsens, Denmark

,

Edoardo Botteri

⁷Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway

⁸Department of Research, Cancer Registry of Norway, Oslo, Norway

,

Marek Bugajski

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

³Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁹Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

,

Michal F. Kaminski

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

³Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁹Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

,

Wladyslaw Januszewicz

³Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

⁹Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland

,

Hjalmar Ødegaard

¹⁰Department of Medicine, Sørlandet Hospital, Flekkefjord, Norway

,

Britta Kleist

¹¹Department of Pathology, Sørlandet hospital, Kristiansand, Norway

,

Mette Kalager

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

¹²Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Magnus Løberg

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

¹²Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Michael Bretthauer

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

¹²Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Geir Hoff

⁷Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway

¹³Department of Medicine, Telemark Hospital Skien, Skien, Norway

,

Asle Medhus

¹⁴Department of Gastroenterology, Oslo University Hospital, Oslo, Norway

,

Øyvind Holme

¹Department of Medicine, Sørlandet Hospital, Kristiansand, Norway

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

⁷Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway

› Institutsangaben

Abstract

Background Endoscopic screening with polypectomy reduces the incidence of colorectal cancer (CRC). Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) in terms of complete polyp resection.

Methods We included patients ≥ 40 years of age at eight hospitals in four countries who had at least one non-pedunculated polyp of 4–9 mm detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP, with a non-inferiority margin of 5 %. Logistic regression models were fitted to identify the factors explaining incomplete resection.

Results 425 patients, with 601 polyps, randomized to either CSP or HSP were included in the analysis. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7 %) and 21 (7.4 %) were incompletely resected, respectively, with an adjusted risk difference of 3.2 % (95 %CI −1.4 % to 7.8 %). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated histology (odds ratio [OR] 3.96; 95 %CI 1.63 to 9.66) and hyperplastic histology (OR 2.52; 95 %CI 1.30 to 4.86) in adjusted analyses.

Conclusion In this randomized trial, non-inferiority for CSP could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared with adenomas. CSP can be used safely for small polyps in routine colonoscopy practice.

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Referenzen

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