Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
Department of Oncology, University of Sheffield, Medical School, Sheffield, UK.
Dig Endosc. 2015 Jul;27(5):603-8. doi: 10.1111/den.12431. Epub 2015 Feb 9.
Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown.
Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation.
One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare.
Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique.
冷圈套技术广泛应用于切除小而微小的息肉。圈套器类型对冷圈套息肉切除术的效果的影响尚不清楚。
采用细丝线迷你圈套器（0.30mm）或粗丝线迷你圈套器（0.47mm）对 3-7mm 息肉行冷圈套息肉切除术。主要结局是内镜下切除的完整性。通过对比染色内镜，标准化并辅助内镜评估，达成了对切除完整性的共识。次要结局包括：组织学切除的完整性、息肉“飞走”、息肉回收率、早期或迟发性出血和穿孔。
共切除 157 个直径 3-7mm 的息肉，62%位于结肠左侧，89.4%为无蒂息肉。与粗丝线圈套器相比，细丝线圈套器的内镜下切除完整性显著更高（90.2%比 73.3%，P<0.05）。虽然细丝线圈套器的完整组织学切除率有升高趋势，但无统计学意义（73.3%比 65.2%，P=0.4）。内镜和组织学切除完整性之间具有中等程度的一致性（kappa=0.36）。细丝线圈套器的息肉“飞走”发生率较低（14.6%比 35.3%，P=0.002），但息肉回收率无显著差异（84.3%比 83.8%，P=0.94）。两种圈套器均无并发症。
在使用冷圈套技术切除小息肉时，圈套器类型似乎是切除完整性的一个重要决定因素。
