Department of Gastroenterology, Sismanogleio-A.Fleming General Hospital, Attiki, Athens 15126, Greece.
Department of Surgery, Aretaieio Hospital, Attiki, Athens 11528, Greece.
World J Gastroenterol. 2018 Apr 14;24(14):1579-1582. doi: 10.3748/wjg.v24.i14.1579.
Standardized approach to polypectomy of diminutive colorectal polyps (DCPs) is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety. This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides well-intentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but non-negligible risk of advanced neoplasia and even cancer. Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps, their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention. Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted.
对于微小结直肠息肉 (DCPs) 的息肉切除术缺乏标准化方法，因为冷活检钳与高复发率相关，热活检钳被认为是不充分和有风险的，而冷圈套目前正在研究其疗效和安全性。这导致了临床实践中的困惑和差距。本文讨论了热活检钳的有用性和当代实际适用性，并对新的欧洲 DCPs 治疗指南提出了善意的批评。微小结直肠息肉是内镜医生感到沮丧的一个原因，因为它们的体积小，伴随着相当大的癌前肿瘤风险，以及较小但不可忽视的进展期肿瘤甚至癌症风险。由于微小结直肠息肉的比例相当大，超过了较大息肉的比例，因此有效地去除它们会带来相当大的工作量和治疗挑战。在过去的十年中，冷圈套已被引入常规内镜检查实践中，试图克服以前的技术，如热活检钳。重要的是要认识到，除了明显不安全和不充分的内镜方法外，所有其他介入性内镜方法都是依赖于操作者的，因为任何治疗干预的成功都需要特定的专业知识和培训。由于关于热活检钳的相关出版物仍然支持其谨慎使用，因为它尚未显示出与新技术相比的劣势，因此任何医疗从业者都应该审慎地评估现有的工具，并根据证据来判断任何新提出的技术，然后再采用。
