Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Toshio Kuwai; Takuya Yamada; Tatsuya Toyokawa; Hiroaki Iwase; Tomohiro Kudo; Naoki Esaka; Hajime Ohta; Haruhiro Yamashita; Yasuo Hosoda; Noriko Watanabe; Naohiko Harada

doi:10.1055/a-0833-8548

Endoscopy, Table of Contents

Endoscopy 2019; 51(03): 253-260
DOI: 10.1055/a-0833-8548

Original article

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Toshio Kuwai

¹Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

,

Takuya Yamada

²Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan

,

Tatsuya Toyokawa

³Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan

,

Hiroaki Iwase

⁴Department of Gastroenterology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

,

Tomohiro Kudo

⁵Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan

,

Naoki Esaka

⁶Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

,

Hajime Ohta

⁷Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan

,

Haruhiro Yamashita

⁸Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan

,

Yasuo Hosoda

⁹Department of Gastroenterology, National Hospital Organization Saitama National Hospital, Saitama, Japan

,

Noriko Watanabe

¹⁰Department of Gastroenterology, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan

,

Naohiko Harada

¹¹Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

› Author Affiliations

Abstract

Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP).

Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis.

Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02).

Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.

Full Text

References

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