Yamashina Takeshi, Fukuhara Manabu, Maruo Takanori, Tanke Gensho, Marui Saiko, Sada Ryota, Taki Mio, Ohara Yoshiaki, Sakamoto Azusa, Henmi Shinichiro, Sawai Yugo, Saito Sumio, Nishijima Norihiro, Nasu Akihiro, Komekado Hideyuki, Sekikawa Akira, Asada Masanori, Tumura Takehiko, Kita Ryuichi, Kimura Toru, Osaki Yukio
Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan.
Endosc Int Open. 2017 Jul;5(7):E587-E594. doi: 10.1055/s-0043-105578. Epub 2017 Jun 23.
Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis.
This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015.
There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, = 0.01).
DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.
对于小型结直肠息肉，冷圈套息肉切除术（CSP）的不良事件发生率较低，尤其是息肉切除术后延迟出血（DPPB）。然而，关于CSP与热息肉切除术（HP）的DPPB发生率比较的数据较少。本研究的目的是评估CSP术后DPPB的发生率，并与HP进行比较。采用倾向评分模型进行二次分析。
这是一项在一家市级医院进行的回顾性队列研究。我们纳入了2013年7月至2015年6月期间接受CSP（330例患者的804枚息肉）或HP（209例患者的530枚息肉）的539例大小为2毫米至11毫米的结直肠息肉患者。
CSP组未发生DPPB病例。相反，HP术后有4例患者（1.9%）发生DPPB，导致CSP组和HP组之间存在显著差异（0.008%对0%，P = 0.02）。倾向评分匹配分析产生了402对匹配对，HP组的DPPB发生率显著高于CSP组（0.02%对0%，P = 0.04）。然而，CSP组中因水平切缘不清楚而无法评估的患者明显更多（83例对38例，P < 0.001）。CSP组的标本回收失败率显著高于HP组（3%对0.7%，P = 0.01）。
根据倾向评分匹配模型选择，CSP的DPPB发生率低于HP。我们的研究结果表明，在日常临床环境中，CSP是推荐的息肉切除术。然而，在息肉回收和水平切缘评估过程中应特别小心，并且这些问题在CSP术后的随访中应予以考虑。
