Background & Aims

There are limited data regarding the safety and efficacy of cold snare polypectomy (CSP) for large colorectal polyps. We evaluated factors affecting the clinical outcomes of CSP for polyps between 5 and 15 mm in size.

Methods

This was a prospective single-center observational study involving 1000 patients undergoing colonoscopy. Polyps (5–15 mm) were removed using CSP, and biopsies were taken from the resection margin. The primary outcome was the incomplete resection rate (IRR), and was determined by the presence of residual neoplasia on biopsy. Correlations between IRR and polyp size, morphology, histology, and resection time were assessed by generalized estimating equation model.

Results

A total of 440 neoplastic polyps were removed from 261 patients. The overall IRR was 2.27%, 1.98% for small (5–9 mm) vs 3.45% for large (10–15 mm) polyps (P = .411). In univariate analysis, the IRR was more likely to be related to sessile serrated lesions (odds ratio [OR], 6.93; 95% confidence interval [CI], 1.88–25.45; P = .004), piecemeal resection (OR, 11.83; 95% CI, 1.20–116.49; P = .034), and prolonged resection time >60 seconds (OR, 7.56; 95% CI, 1.75–32.69; P = .007). In multivariable regression analysis, sessile serrated lesions (OR, 6.45; 95% CI, 1.48–28.03; P = .013) and resection time (OR, 7.39; 95% CI, 1.48–36.96; P = .015, respectively) were independent risk factors for IRR. Immediate bleeding was more frequent with resection of large polyps (6.90% vs 1.42%; P = .003). No recurrence was seen on follow-up colonoscopy in 37 cases with large polyps.

Conclusions

CSP is safe and effective for removal of colorectal polyps up to 15 mm in size, with a low IRR. (ClinicalTrials.gov; Number: NCT03647176).

中文翻译：

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冷圈套息肉切除术对大、小结直肠息肉不完全切除率的比较

背景与目标

关于大结直肠息肉冷圈套息肉切除术 (CSP) 的安全性和有效性的数据有限。我们评估了影响 5 至 15 毫米息肉 CSP 临床结果的因素。

方法

这是一项前瞻性单中心观察性研究，涉及 1000 名接受结肠镜检查的患者。使用 CSP 去除息肉 (5–15 mm)，并从切除边缘进行活检。主要结果是不完全切除率 (IRR)，并由活检中是否存在残留瘤决定。通过广义估计方程模型评估 IRR 与息肉大小、形态、组织学和切除时间之间的相关性。

结果

共切除了 261 名患者的 440 颗肿瘤性息肉。总体 IRR 为 2.27%，小息肉 (5-9 mm) 为 1.98%，大息肉 (10-15 mm) 为 3.45% ( P = .411)。在单变量分析中，IRR 更可能与无蒂锯齿状病变（比值比 [OR]，6.93；95% 置信区间 [CI]，1.88–25.45；P = .004）、分块切除术（OR，11.83； 95% CI，1.20–116.49；P = .034）和延长的切除时间 >60 秒（OR，7.56；95% CI，1.75–32.69；P = .007）。在多变量回归分析中，无蒂锯齿状病变（OR，6.45；95% CI，1.48–28.03；P = .013）和切除时间（OR，7.39；95% CI，1.48–36.96；P =.015）是 IRR 的独立危险因素。即刻出血在大息肉切除术中更常见（6.90% 对 1.42%；P = .003）。37例大息肉经结肠镜随访未见复发。

结论

CSP 可安全有效地切除最大 15 毫米的结直肠息肉，且 IRR 较低。（ClinicalTrials.gov；编号：NCT03647176）。