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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(05): E602-E608
DOI: 10.1055/a-1785-8616
Original article

Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection

Junki Toyosawa
1   Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
2   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Yasushi Yamasaki
1   Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
2   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Tsuyoshi Fujimoto
1   Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
,
Shouichi Tanaka
1   Department of Gastroenterology, Iwakuni Clinical Center, Yamaguchi, Japan
,
Takehiro Tanaka
3   Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Toshiharu Mitsuhashi
4   Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
,
Hiroyuki Okada
2   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
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Abstract

Background and study aims Small colorectal polyps are removed by various methods, including cold snare polypectomy (CSP), hot snare polypectomy (HSP), and underwater endoscopic mucosal resection (UEMR), but the indications for using these methods are unclear. We retrospectively assessed the efficacy of CSP, HSP, and UEMR for small polyps, focusing on the depth of the resected specimens.

Patients and methods Outpatients with non-pedunculated small polyps (endoscopically diagnosed as 6 to 9 mm), resected by two endoscopists between July 2019 and September 2020, were enrolled. We histologically evaluated the specimens resected via CSP, HSP, and UEMR. The main outcome was the containment rate of the muscularis mucosa (MM) and submucosa (SM) tissues.

Results Forty polyps resected via CSP (n = 14), HSP (n = 12), or UEMR (n = 14) were enrolled after excluding 13 polyps with resection depths that were difficult to determine. The rates of specimens containing MM and SM tissue differed significantly (57 % and 29 % for CSP, 92 % and 83 % for HSP, and 100 % and 100 % for UEMR, respectively (P = 0.005 for MM and P < 0.001 for SM tissue). Multiple logistic regression analysis showed UEMR was an independent factor relating to the containment of SM tissue. The thickness of SM tissue by CSP, HSP, and UEMR were 52 μm, 623 μm, and 1119 μm, respectively (P < 0.001). The thickness by CSP was significantly less than those by HSP and UEMR (P < 0.001, Bonferroni correction).

Conclusions UEMR could be the best method to contain SM tissue without injection. Further studies are needed to evaluate the indication of UEMR for small polyps.

Supplementary material



Publication History

Received: 22 October 2021

Accepted: 26 November 2021

Article published online:
13 May 2022

© 2022. 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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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(06): 631-631
DOI: 10.1055/a-1748-1088

Refers to:

Resection depth: a very important advantage for underwater EMREndosc Int Open 2022; 10(06): E729-E730
DOI: 10.1055/a-1795-7635

 

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