Endoscopy 2019; 51(04): S183-S184
DOI: 10.1055/s-0039-1681713
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: Colon: resection 5 ePoster Podium 2
Georg Thieme Verlag KG Stuttgart · New York

COLD SNARE POLYPECTOMY VS HOT SNARE POLYPECTOMY VS ARGON PLASMA COAGULATION (APC) FOR 5 – 9MM LEFT-SIDED COLORECTAL POLYPS: A PROSPECTIVE RANDOMIZED TRIAL

L Varytimiadis
1   Gastroenterology, Evangelismos Hospital, Athens, Greece
,
N Viazis
1   Gastroenterology, Evangelismos Hospital, Athens, Greece
,
V Papastergiou
2   Gastroenterology, ''Konstantopoulio'' General Hospital, Athens, Greece
,
G Kyriakopoulos
3   Department of Pathology, Evangelismos Hospital, Athens, Greece
,
T Argyrakos
3   Department of Pathology, Evangelismos Hospital, Athens, Greece
,
C Pontas
1   Gastroenterology, Evangelismos Hospital, Athens, Greece
,
I Papanikolaou
4   Hepato-Gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
,
N Arkadopoulos
5   4th Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
,
V Smirniotis
5   4th Department of Surgery, Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
,
G Mantzaris
1   Gastroenterology, Evangelismos Hospital, Athens, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The optimal technique for the removal of small colorectal polys is debatable. We aimed to compare the recurrence rates among three endoscopic treatment modalities for 5 – 9 mm left-sided colorectal polyps.

Methods:

Consecutive adults referred for elective colonoscopy (1/2015 – 1/2018) who had at least one polyp of eligible size (5 – 9 mm) located distally to the splenic flexure were randomly assigned (1:1:1) to one of three treatment modalities: 1) Cold Snare Polypectomy (CSP), 2) Hot Snare Polypectomy (HSP) and 3) APC ablation (50 – 60W, flow: 2lt/min). The polyp site was marked with endoscopic tattoo and a follow-up colonoscopy with scar biopsies was performed 6 – 18months after the index procedure. Outcomes were the polyp recurrence rate and the occurrence of complications.

Results:

A total of 119 patients were enrolled, of which 7 dropped out because of non follow-up. Eventually they were included 112 patients (62.5% males, mean age 61.1 ± 9.9 years) with 121 polyps (CSP: 39, HSP: 45, APC: 37) who returned for follow-up colonoscopy. The mean polyp size was 6.7 ± 0.91 mm, 58% were located in the sigmoid, 33% in the rectum and 8% in the descending colon. The majority of polyps resected by CSP or HSP were histopathologically proven to be neoplastic (tubular adenomas: 25.9%, tubulovillous adenomas: 11.1%, sessile serrate adenomas/polyps: 17.5%). No cases of delayed bleeding or perforation occurred in the study. Scar biopsies at follow-up colonoscopy (performed after a mean interval of 13.4 ± 3.8 months) revealed a total of 7 (5.8%) cases of polyp recurrence, showing no significant difference among the three treatment groups [CSP: 3/39 (7.7%), HSP: 1/45 (2.2%), APC: 2/37 (5.4%), P = 0.51).

Conclusions:

CSP, HSP and APC ablation are effective and safe treatment modalities for 5 – 9 mm left-sided colorectal polyps. The present randomized study could not detect any differences in the polyp recurrence rates among the three endoscopic techniques.