Background and Aims

A limitation of determination of the completeness of resection in polypectomy is polyp fragmentation. When a polyp fragments, the pathologist cannot determine resection completeness. Alternative approaches to reduce polyp fragmentation include reducing shearing forces on the polyp or removing polyps through the instrument channel. The primary aim of this study was to assess fragmentation of polyps extracted using different approaches from conventional polyp retrieval.

Methods

Polyps (5-15 mm) resected by cold snare or cautery by 3 colonoscopists were extracted from the colonoscope using 1 of 4 techniques. Method I was the conventional method of pressing the suction valve button and retrieving the polyp through a trap. Method II involved removing the suction valve, covering the open suction valve cylinder with a finger. Method III used a Roth Net polyp retriever placed through the instrument channel. Method IV involved connecting a polyp trap to suction onto the instrument channel port. Fragmentation was defined as multiple pieces of the specimen in formalin, as grossly described by the pathologist. Alternative approaches (methods II, III, and IV) were all compared with the conventional method (method I).

Results

The method I fragmentation rate of polyps was 60.3% (123/204). Method II extraction reduced fragmentation to 43.0% (52/121, P = .003), proving that fragmentation occurs with passage through the suction valve channel. Method III had a lower fragmentation rate of 23.1% (6/26, P < .001). Method IV likewise showed a reduced fragmentation rate of 18.5% (5/27, P < .001).

Conclusions

Polyp fragmentation is reduced by removal of the suction valve button. There is also a decrease in fragmentation rates in removing the polyp by connecting the polyp trap to the instrument port. Our study suggests that decreasing polyp fragmentation and improving pathology margin interpretability is possible through methods that extract polyps through the instrument port with currently available devices.

中文翻译：

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结肠镜检查中息肉提取的替代方法：原理研究的证明

背景和目标

在息肉切除术中确定切除完整性的局限性是息肉碎片化。当息肉破裂时，病理学家无法确定切除的完整性。减少息肉碎片的替代方法包括减少息肉上的剪切力或通过器械通道去除息肉。这项研究的主要目的是评估使用与常规息肉取材方法不同的方法提取的息肉碎片。

方法

使用4种技术中的一种从结肠镜中取出由3名结肠镜检查者切除的由冷圈套器或烧灼切除的息肉（5-15 mm）。方法I是按下吸气阀按钮并通过陷阱取回息肉的常规方法。方法II涉及卸下吸气阀，用手指覆盖打开​​的吸气阀气缸。方法III使用通过仪器通道放置的Roth Net息肉取出器。方法IV涉及连接息肉阱以将其抽吸到仪器通道端口上。碎裂被定义为福尔马林中的多块标本，病理学家对此进行了粗略的描述。所有替代方法（方法II，III和IV）均与常规方法（方法I）进行了比较。

结果

方法I息肉的碎裂率为60.3％（123/204）。方法II提取可将碎片减少到43.0％（52/121，P  = .003），证明碎片会在通过吸入阀通道时发生。方法III的碎裂率较低，为23.1％（6/26，P  <.001）。方法IV同样显示出减少的碎片率18.5％（5/27，P  <.001）。

结论

息肉碎片的减少可通过取下吸入阀按钮来减少。通过将息肉捕获器连接到仪器端口来移除息肉时，碎片率也会降低。我们的研究表明，通过使用当前可用设备通过仪器端口提取息肉的方法，可以减少息肉碎片并提高病理学界限的可解释性。