Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Vasilios Papastergiou; Konstantina D. Paraskeva; Maria Fragaki; Ioannis Dimas; Emmanouil Vardas; Angeliki Theodoropoulou; Nicoletta Mathou; Athanasios Giannakopoulos; Konstantinos Karmiris; Afroditi Mpitouli; Dimitra Apessou; Linda Giannikaki; John A. Karagiannis; Grigorios Chlouverakis; Gregorios A. Paspatis

doi:10.1055/s-0043-118594

Endoscopy, Inhaltsverzeichnis

Endoscopy 2018; 50(04): 403-411
DOI: 10.1055/s-0043-118594

Original article

Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Vasilios Papastergiou

¹Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece

,

Konstantina D. Paraskeva

¹Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece

,

Maria Fragaki

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Ioannis Dimas

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Emmanouil Vardas

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Angeliki Theodoropoulou

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Nicoletta Mathou

¹Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece

,

Athanasios Giannakopoulos

¹Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece

,

Konstantinos Karmiris

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Afroditi Mpitouli

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

,

Dimitra Apessou

³Department of Histopathology, Konstantopouleio General Hospital, Athens, Greece

,

Linda Giannikaki

⁴Department of Histopathology, Venizeleio General Hospital, Heraklion, Greece

,

John A. Karagiannis

¹Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece

,

Grigorios Chlouverakis

⁵Department of Social Medicine, University of Crete, Medical College, Heraklion, Greece

,

Gregorios A. Paspatis

²Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece

› Institutsangaben

Abstract

Background and study aims Cold snare polypectomy is an established method for the resection of small colorectal polyps; however, significant incomplete resection rates still leave room for improvement. We aimed to assess the efficacy of cold snare endoscopic mucosal resection (CS-EMR), compared with hot snare endoscopic mucosal resection (HS-EMR), for nonpedunculated polyps sized 6 – 10 mm.

Patients and methods This study was a dual-center, randomized, noninferiority trial. Consecutive adult patients with at least one nonpedunculated polyp sized 6 – 10 mm were enrolled. Eligible polyps were randomized (1:1) to be treated with either CS-EMR or HS-EMR. Both methods involved submucosal injection of a methylene blue-tinted normal saline solution. The primary noninferiority end point was histological eradication evaluated by postpolypectomy biopsies (noninferiority margin – 10 %). Secondary outcomes included occurrence of intraprocedural bleeding, clinically significant postprocedural bleeding, and perforation.

Results Among 689 patients screened, 155 patients with 164 eligible polyps were included (CS-EMR n = 83, HS-EMR n = 81). The overall rate of histological complete resection was 92.8 % in the CS-EMR group and 96.3 % in the HS-EMR group (difference 3.5 %; 95 % confidence interval [CI] – 4.15 to 11.56), showing noninferiority of CS-EMR compared with HS-EMR. CS-EMR was shown to be noninferior both for polyps measuring 6 – 7 mm (CS-EMR 93.3 %; HS-EMR 100 %; 95 %CI – 7.95 to 21.3) and those of 8 – 10 mm (92.5 % vs. 94.7 %, respectively; 95 %CI – 7.91 to 13.16). Rates of intraprocedural bleeding were similar between the two groups (CS-EMR 3.6 %, HS-EMR 1.2 %; P = 0.30). No clinically significant postprocedural bleeding or perforation occurred in either group.

Conclusions CS-EMR appears to be a valuable modification of the standard cold snare technique, obviating the need to use diathermy for nonpedunculated colorectal polyps sized 6 – 10 mm.

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Referenzen

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