Endoscopy 2004; 36(5): 432-436
DOI: 10.1055/s-2004-814321
Original Article
© Georg Thieme Verlag Stuttgart · New York

Histological Quality of Polyps Resected Using the Cold Versus Hot Biopsy Technique

K.  E.  Mönkemüller1 , L.  C.  Fry1 , B.  H.  Jones1 , C.  Wells1 , I.  Mikolaenko2 , M.  Eloubeidi1
  • 1Division of Gastroenterology, Veterans’ Association Medical Center and University of Alabama, Birmingham, Alabama, USA
  • 2Dept. of Pathology, Veterans’ Association Medical Center and University of Alabama, Birmingham, Alabama, USA
Weitere Informationen

Publikationsverlauf

Submitted 23 June 2003

Accepted after Revision 9 November 2003

Publikationsdatum:
21. April 2004 (online)

Background and Study Aims: The monopolar hot biopsy technique is a widespread method of removing and cauterizing small colonic polyps. Due to the insulated cups of the biopsy forceps, it also allows adequate histological interpretation of the resected specimen. In our experience, polyps removed using the monopolar hot biopsy technique have been less histologically interpretable in comparison with polyps removed using cold biopsy forceps. The aim of this study was to assess and compare the diagnostic quality of polyps obtained using the hot biopsy and cold biopsy techniques.
Patients and Methods: This was a prospective study of consecutive patients undergoing colonoscopy with removal of polyps using either hot biopsy or cold biopsy techniques. One experienced endoscopist using the same techniques carried out the biopsies. An experienced gastrointestinal pathologist, blinded to the technique used, evaluated the specimens for diameter, artifacts, cautery damage, tissue fragmentation, and general histological and diagnostic quality. Statistical analysis was carried out using the chi-squared test, Fisher’s exact test, and Student’s t-test.
Results: Forty-three consecutive patients (84 % men; mean age 63.8 ± 15 years) underwent 88 biopsies (45 hot biopsies and 43 cold biopsies). There were no statistically significant differences between the two study groups with regard to demographic data, indications for colonoscopy, endoscopic findings, or polyp size. Cautery damage, architectural distortion, and tissue fragmentation occurred more frequently in polyps resected using the hot biopsy technique (P < 0.001).
Conclusions: The quality of the specimens removed by cold biopsy was generally better than when using hot biopsy technique. Histological evaluation is more difficult in polyps resected with the hot biopsy technique in comparison with the cold biopsy technique. When the nature of polyps affects the patient’s management, a biopsy may be obtained before polyp coagulation.

References

  • 1 Gilbert D A, DiMarino A J, Jensen D M. et al . Status evaluation: hot biopsy forceps.  Gastrointest Endosc. 1992;  38 753-756
  • 2 Mann N S, Mann S K, Alam I. The safety of hot biopsy forceps in the removal of small colonic polyps.  Digestion. 1999;  60 74-76
  • 3 Woods A, Sanowski R A, Wadas D D. et al . Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal.  Gastrointest Endosc. 1989;  35 536-540
  • 4 Kimmey M B, Silverstein F E, Saunders D R, Haggit R C. Endoscopic bipolar forceps: a potential treatment for the diminutive polyp.  Gastrointest Endosc. 1988;  34 38-41
  • 5 Bond J H. Adenomatous polyps and adenocarcinoma of the colon. In: DiMarino AJ Jr, Benjamin SB (eds) Gastrointestinal disease: an endoscopic approach. Malden, Massachusetts; Blackwell Science 1997: 615-624
  • 6 Baillie J. Gastrointestinal endoscopy. Boston; Butterworth-Heinemann 1997: 52-63
  • 7 Barlow D E. Endoscopic applications of electrosurgery: a review of basic principles.  Gastrointest Endosc. 1982;  28 73-76
  • 8 Vanagunas A, Jacob P, Vakil N. Adequacy of ”hot biopsy” for the treatment of diminutive polyps: a prospective randomized trial.  Am J Gastroenterol. 1989;  84 383-385
  • 9 Fantin A C, Neuweiler J, Binek J S. et al . Diagnostic quality of biopsy specimens: comparison between forceps and Multibite forceps.  Gastrointest Endosc. 2001;  54 600-604
  • 10 Rex D K, Alikhan M, Cummings O, Ulbright Y M. Accuracy of pathologic interpretation of colorectal polyps by general pathologists in community practice.  Gastrointest Endosc. 1999;  50 468-474
  • 11 Waye J D, Lewis B S, Frankel A, Geller S A. Small colon polyps.  Am J Gastroenterol. 1988;  83 120-122
  • 12 Turk D J, Kozarek R A, Botoman V A. et al . Disposable endoscopic biopsy forceps: comparison with standard forceps of sample size and adequacy of specimen.  J Clin Gastroenterol. 1991;  13 76-78
  • 13 Külling D, Christ A D, Karaasalan N. et al . Is histological investigation of polyps always necessary?.  Endoscopy. 2001;  33 428-432
  • 14 Atkin W S, Morson B C, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenoma.  N Engl J Med. 1992;  326 658-662
  • 15 Granqvist S, Gabrielson N, Sundelin P. Diminutive colonic polyps of the colon: clinical significance and management.  Endoscopy. 1979;  36 1-5
  • 16 Tedesco F J, Hendrix J C, Pickens C A. et al . Diminutive polyps: spatial distribution and clinical significance.  Gastrointest Endosc. 1982;  28 1-4
  • 17 Hoff G, Foerster A, Vatn M H. et al . Epidemiology of polyps in the rectum and colon: recovery and resection of unresected polyps two years after detection.  Scand J Gastroenterol. 1986;  21 853-857
  • 18 Spencer R J, Melton L J, Ready R L. Treatment of small colorectal polyps: a population-based study of the risk of subsequent carcinoma.  Mayo Clin Proc. 1984;  59 305-310
  • 19 Muto T, Kamiya J, Sawada T. et al . Small ”flat” adenoma of the large bowel with special reference to its clinicopathologic features.  Dis Colon Rectum. 1985;  28 847-854
  • 20 Stolte M, Bethge B. Colorectal mini/de novo carcinoma: a reality in Germany too.  Endoscopy. 1995;  27 286-290
  • 21 Rembacken B J, Fujii T, Cairns A. et al . Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK.  Lancet. 2000;  355 1211-1214
  • 22 Tytgat G NJ, Ignacio J G. Technicalities of endoscopic biopsy.  Endoscopy. 1995;  27 683-688
  • 23 Woods K L, Bhupinder S A, Cole R A. et al . Influence of endoscopic biopsy forceps characteristics on tissue specimens: results of a prospective randomized study.  Gastrointest Endosc. 1999;  49 177-183
  • 24 Danesh B JZ, Burke M, Newman J. et al . Comparison of weight, depth, and diagnostic adequacy of specimens obtained with 16 different biopsy forceps designed for upper gastrointestinal endoscopy.  Gut. 1985;  26 227-231

K. E. Mönkemüller, M.D.

East Valley Gastroenterology and Hepatology Associates

9065 E Wood Dr. · Scottsdale, AZ 85260 · USA

Fax: +1-480-786-6996 ·

eMail: monkemuller@aol.com