Endoscopy 2020; 52(S 01): S41-S42
DOI: 10.1055/s-0040-1704129
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 10:30 – 12:00 Innocent & guilty polyps Wicklow Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

A MULTICENTRE RANDOMIZED CONTROLLED TRIAL COMPARING THE RESECTION RATE AND COMPLICATIONS FOR COLD AND HOT SNARE POLYPECTOMY FOR 5-9 MM COLORECTAL POLYPS (POLIPEC HOT-COLD)

M BenitoSanz
1   Hospital Universatorio Río Hortega, Gastroenterology, Valladolid, Spain
,
LH Villalba
2   Hospital Santos Reyes, Gastroenterology, Aranda de Duero, Spain
,
J García-Alonso
1   Hospital Universatorio Río Hortega, Gastroenterology, Valladolid, Spain
,
PD Redondo
1   Hospital Universatorio Río Hortega, Gastroenterology, Valladolid, Spain
,
HN Rodríguez
1   Hospital Universatorio Río Hortega, Gastroenterology, Valladolid, Spain
,
JMG Santiago
3   Complejo Hospitalario de Salamanca, Gastroenterology, Salamanca, Spain
,
DJ Matías
3   Complejo Hospitalario de Salamanca, Gastroenterology, Salamanca, Spain
,
RT Yuste
4   Hospital de Segovia, Gastroenterology, Segovia, Spain
,
JS Fernández
5   Hospital Río Carrión, Gastroenterology, Palencia, Spain
,
MC Román
5   Hospital Río Carrión, Gastroenterology, Palencia, Spain
,
CT Sánchez
6   Hospital de Medina del Campo, Gastroenterology, Valladolid, Spain
,
MI García
6   Hospital de Medina del Campo, Gastroenterology, Valladolid, Spain
,
AG Arévalo
7   Hospital de Fuenlabrada, Gastroenterology, Madrid, Spain
,
JF Pérez
8   Complejo Hospitalario de Salamanca, Pathological Anatomy, Salamanca, Spain
,
M Pérez-Miranda
1   Hospital Universatorio Río Hortega, Gastroenterology, Valladolid, Spain
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Publikationsverlauf

Publikationsdatum:
23. April 2020 (online)

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    Aims To compare the outcome of cold snare polypectomy (CSP) vs hot snare polypectomy (HSP) regarding incomplete resection rates and adverse events rates in 5-9mm colorectal polyps.

    Tab. 1

    Cold snare (n=364)

    Hot snare (n=376)

    p

    Size (mm), median (RIC)

    6 (5-7)

    6 (5-7)

    0.82

    Location - Left colon - Right colon

    182 (50%)

    182 (50%)

    182 (48.4%)

    194 (51.6%)

    0.66

    Shape

    - Is

    - Ip

    - Isp

    - IIa/b/c

    235 (64.6%)

    23 (6.3%)

    10 (2.8%)

    96 (26.4%)

    223 (59.3%)

    31 (8.2%)

    19 (5.1%)

    103 (27.4%)

    0.37

    Methods A prospective, multicentre, randomized controlled trial conducted in 7 Spanish Endoscopy Units (NCT03783156). Subjects with at least one 5-9mm polyp were randomized either to CSP or HSP. Polypectomies were performed according to current guidelines, without injection. Snare types and sizes were chosen by endoscopists. Complete resection rates were assessed with two biopsy samples taken after polipectomy and evaluated by a single pathologist blind to the specimen analysis and polypectomy method. Adverse effects were assessed by a standardized questionnaire. Differences between proportions of incomplete polypectomies were assessed with the z test of homogeneity.

    Results A total 1437 patients were screened for eligibility, finally including 456 subjects (median age 64.8 (IQR: 57.2-71), 297 (65.1%) males), with 740 eligible polyps (364 assigned to CSP and 376 to HSP). Most frequent indications were colorectal cancer screening (32.5%), symptomatic patients (24.1%) and postpolipectomy follow-up (23.2%).

    Lesions included are summarized in [Table 1]. Incomplete polypectomy rates were 8.6% in CSP group and 6.9% with HSP (p=ns). Post procedural pain remained similar between both groups until 5h after the procedure, when pain was present in14% of patients of the HSP group and in 6% of the CSP group (p=0.06). Overall adverse events presented similarly between the CSP and HSP groups (8.8% vs 12%, respectively), with no differences in postpolipectomy bleeding rates (0.5% vs 0,4%).

    Conclusions Cold snare polypectomy is a safe and effective technique in colonic lesions of 5-9 mm.


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