Background and Aims

The criteria for a standard polypectomy technique for complete removal of small colorectal polyps has not yet been established. This study aimed to compare the complete resection rate of hot snare polypectomy (HSP) with that of EMR for small, sessile, or flat polyps.

Methods

Patients with 5- to 9-mm non-pedunculated colorectal polyps were prospectively randomized to the HSP or EMR group. The presence of residual polyps was assessed by performing histologic assessment of 4-quadrant forceps biopsy specimens taken from the edges of the polypectomy site. The primary outcome was the complete resection rate after HSP or EMR; the secondary outcomes were the proportion of procedure-related adverse events and specimen-loss rate. Sample size was estimated using a superiority trial design. We assumed that the complete resection rate of the EMR group would be at least 8% higher than that of the HSP group.

Results

A total of 382 polyps in 269 patients were assessed and randomly assigned to each method using 4 × 4 block randomization. Of these, 353 polyps were finally analyzed based on the pathology results. The mean polyp size was 6.3 ± 1.3 mm. The complete resection rate did not differ between the HSP and EMR groups (88.4% [152/172] vs 92.8% [168/181], respectively; P = .2). The intraprocedural bleeding rate, immediately after polypectomy, was significantly higher in the HSP group than in the EMR group (5.2% vs 0.6%, respectively; P = .009). However, clinically significant bleeding and tissue retrieval failure rates did not differ between the groups. In the multivariate logistic regression analysis, sessile serrated adenoma/polyps or hyperplastic polyps were almost 3 times (odds ratio, 2.824; 95% confidence interval, 1.03-7.75; P = .044) more likely to be incompletely resected compared with other conventional adenomatous polyps. Except for pathology, we found no significant independent predictors for incomplete resection.

Conclusion

EMR for small non-pedunculated colorectal polyps is not superior to HSP in terms of complete resection or safety. Both methods can be performed according to the endoscopist’s preference. (Clinical trial registration number: KCT0001640; cris.nih.go.kr.)

中文翻译：

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带或不带盐溶液/肾上腺素提升术的热圈套息肉切除术，可完全切除大肠息肉

背景和目标

完全切除小肠息肉的标准息肉切除术技术标准尚未建立。本研究旨在比较小，无柄或扁平息肉的热圈套息肉切除术（HSP）与EMR的完全切除率。

方法

患有5至9毫米无蒂大肠息肉的患者前瞻性随机分为HSP或EMR组。残留息肉的存在通过对从息肉切除部位边缘取出的四象限镊子活检标本进行组织学评估来评估。主要结局是HSP或EMR后的完全切除率。次要结果是与手术相关的不良事件的比例和标本丢失率。使用优势试验设计估算样本量。我们假设EMR组的完全切除率比HSP组至少高8％。

结果

评估了269例患者中的382例息肉，并使用4×4块随机分配将其随机分配给每种方法。其中，根据病理结果最终分析了353例息肉。息肉的平均大小为6.3±1.3毫米。HSP和EMR组之间的完全切除率没有差异（分别为88.4％[152/172]对92.8％[168/181]；P  = 0.2）。在HSP组中，息肉切除后的术中出血率显着高于EMR组（分别为5.2％和0.6％；P = .009）。但是，两组之间临床上明显的出血和组织修复失败率没有差异。在多因素logistic回归分析中，无柄锯齿状腺瘤/息肉或增生性息肉比 其他常规腺瘤几乎更容易切除3倍（奇数比，2.824； 95％置信区间，1.03-7.75；P = .044）。息肉。除病理学外，我们未发现不完全切除的重要独立预测因子。

结论

在完全切除或安全性方面，小型非带蒂结直肠息肉的EMR并不优于HSP。两种方法都可以根据内镜医师的偏爱进行。（临床试验注册号：KCT0001640； cris.nih.go.kr。）