Background and Goals: 

There is variation in polypectomy techniques for resection of small polyps. Aim was to compare techniques for 4 to 6 mm polyps for recurrent adenoma, efficiency, and adverse events and to establish methodological factors for definitive trial.

Materials and Methods: 

The study was a randomized controlled trial. Outpatients with ≥1, 4 to 6 mm polyps were randomized to cold forceps (CF), cold snare (CS), and hot snare (HS). Polypectomy site was marked with SPOT to assess for recurrence at the original polypectomy site during surveillance colonoscopy. To assess feasibility of a definitive trial we measured (1) rates of patient refusal, participation, ineligibility; (2) retention; (3) recurrent neoplasia; and (4) sample size for a definitive trial.

Results: 

Three hundred fifty-three patients were randomized to 1 of the 3 polypectomy techniques, of whom 260 (73.6%) completed the initial colonoscopy (mean age 57 y, 50.4% women), with 91, 87, and 82 patients randomized to CF, CS, and HS polypectomy, respectively. Mean time for polyp resection for CF, CS, and HS were 198.8, 58.5, and 96.8 seconds, respectively, with CS and HS requiring less time than CF (P<0.001). One hundred sixty-four (63.1%) completed surveillance colonoscopy. Polyp recurrences were 9 (14.5%) with CF, 5 (9.6%) with CS, and 0 (0%) with HS. Although the recurrence relative risks with CF and CS polypectomy were 1.84 and 1.65 as compared with HS, respectively, neither was statistically significant.

Conclusions: 

CS and HS polypectomy require less time than CF. HS polypectomy may have a lower risk for recurrent neoplasia. High attrition rate is a challenge in conducting randomized controlled trial with polyp recurrence as endpoint.

中文翻译：

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4 至 6 毫米结肠息肉息肉切除术技术的随机试验

背景和目标： 

切除小息肉的息肉切除技术存在差异。目的是比较治疗 4 至 6 毫米息肉复发性腺瘤的技术、效率和不良事件，并确定最终试验的方法学因素。

材料和方法： 

该研究是一项随机对照试验。≥1、4 至 6 mm 息肉的门诊患者被随机分配至冷钳 (CF)、冷圈套器 (CS) 和热圈套器 (HS)。息肉切除部位用 SPOT 标记，以在监测结肠镜检查期间评估原始息肉切除部位的复发情况。为了评估最终试验的可行性，我们测量了（1）患者拒绝率、参与率、不合格率；(2) 保留；(3)复发性肿瘤；(4) 最终试验的样本量。

结果： 

353 名患者被随机分配至 3 种息肉切除术中的一种，其中 260 名 (73.6%) 完成了初始结肠镜检查（平均年龄 57 岁，50.4% 为女性），其中 91、87 和 82 名患者被随机分配至 CF、分别是 CS 和 HS 息肉切除术。CF、CS 和 HS 的平均息肉切除时间分别为 198.8、58.5 和 96.8 秒，其中 CS 和 HS 需要的时间少于 CF（P <0.001）。一百六十四名 (63.1%) 完成了监测结肠镜检查。CF 时息肉复发率为 9 例（14.5%），CS 时息肉复发率为 5 例（9.6%），HS 时息肉复发率为 0 例（0%）。尽管与 HS 相比，CF 和 CS 息肉切除术的复发相对风险分别为 1.84 和 1.65，但两者均无统计学意义。

结论： 

CS 和 HS 息肉切除术比 CF 需要更少的时间。HS 息肉切除术可能会降低肿瘤复发的风险。高流失率是进行以息肉复发为终点的随机对照试验的一个挑战。