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ENDOSCOPIC RESECTION OF A PEDUNCLATED TYPE ADENOMA: PROS AND CONS OF COLD SNARE POLYPECTOMY

Naohiko Akimoto 1, Osamu Goto 1, Yumiko Ishikawa 1, Eriko Koizumi 1, AITOSHI HOSHIMOTO 1, Kazutoshi Higuchi 1, Takayoshi Nishimoto 1, Jun Omori 1, Atsushi Tatsuguchi 1, Ryuji Ohashi 1, Katshiko Iwakiri 1

Affiliations

1 Nippon Medical School, Tokyo, Japan

Summary

AI Generated

A retrospective Japanese study of 85 pedunculated (Ip type) adenomas suggests cold snare polypectomy achieved lower complete resection rates than hot polypectomy or EMR for lesions 6 mm or greater, but showed comparable outcomes for lesions 5 mm or less.

Among 23 pedunculated adenomas treated with cold snare polypectomy, the R0 resection rate was significantly lower than hot polypectomy or EMR (61% versus 90%, p=0.03), with the difference driven by lesions 6 mm or greater.
For pedunculated adenomas 5 mm or less, cold snare polypectomy showed no significant difference in R0 resection rates compared to hot techniques (59% versus 50%).
No perforation occurred in any group; postoperative bleeding was observed only in non-pedunculated lesions treated with cold snare polypectomy (0.7%).
The authors conclude that hot polypectomy or EMR should be selected for pedunculated adenomas 6 mm or greater, while cold snare polypectomy may be acceptable for those 5 mm or less.
This material is relevant to endoscopists selecting resection techniques for small pedunculated colorectal adenomas.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

While cold snare polypectomy (CSP) has been proven effective and safe in the resection of small polyps, it is not actively recommended for the pedunculated (Ip type) polyps in the European Society and Gastrointestinal Endoscopy and US Multi-Society Task Force on Colorectal Cancer guidelines. Although Japanese guidelines recommend that CSP should be limited to lesions less than 10 mm, preoperatively diagnosed as adenomas, the guideline does not address how to resect pedunculated (Ip type) adenomas. This study aims to examine the pros and cons of CSP for the resection of Ip type adenoma.

Aims & Methods

Among patients with colorectal adenomas resected endoscopically at Nippon Medical School Hospital in Japan, from January to July 2020, 85 lesions in 67 consecutive cases of type Ip, and 762 lesions in 346 cases of non-Ip type (types Is, Isp, and II) resected by CSP, were observed. Regarding clinicopathologic features, R0 resection rate, and adverse events, we evaluated the difference in the resection method (Ip-CSP group vs Ip-hot polypectomy (HP)/EMR group) as Study 1; and the macroscopic classifications (Ip-CSP group vs Non-Ip-CSP group) as Study 2.

Results

In Study 1, 23 lesions were included in the Ip-CSP group and 62 lesions were included in the Ip-HP/EMR group. A higher percentage of proximal colon lesions (74% vs. 27%, p<0.001) and smaller mean tumor size (5.1±1.6mm vs. 11±5.0mm, p<0.001) were observed in the Ip-CSP group, compared to Ip-hot polypectomy (HP)/EMR group. The R0 resection rate was also significantly lower in Ip-CSP group (61% vs. 90%, p=0.03). While the R0 resection rate tended to be low for lesions 6 mm or greater (67%/93%), no difference was observed among lesions less than 5 mm (59%/50%). No perforation or postoperative bleeding was observed in both groups. In Study 2 using 23 lesions for the Ip-CSP group and 762 lesions for the Non-Ip-CSP group, no significant difference was observed in tumor location or mean tumor diameter, as well as R0 resection rates (61% vs. 45%, p=0.13). No perforation was observed in either group. Postoperative bleeding was observed only in the Non-Ip group for 5 lesions (0.7%).

Conclusion

To achieve pathological complete resection for Ip adenomas, HP/EMR should be selected for adenoma with a diameter of 6 mm or greater. Conversely, CSP was considered acceptable for lesions of 5 mm or less. Further studies with a larger number of patients are warranted.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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