Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
PLoS One. 2019 Mar 1;14(3):e0213281. doi: 10.1371/journal.pone.0213281. eCollection 2019.
Factors associated with efficacy and safety of cold snare polypectomy (CSP) are not well established. The aim is to elucidate the predictors of R0 resection and immediate bleeding of CSP.
We retrospectively reviewed a database of patients who underwent CSP for subcentimetric polyps at the University of Tokyo Hospital in Japan. Using the data regarding the characteristics of patients and polyps, such as location, size, and macroscopic appearance; use of narrow band imaging with magnification (NBI-M); and endoscopists' experience, we revealed the predictive factors associated with R0 resection and immediate post-CSP bleeding by univariate and multivariate analyses.
In total, 399 polyps, in 200 patients without antithrombotics, were removed. Failure of tissue retrieval was noted in 4% of resected lesions. There was no intramucosal carcinoma observed. The overall rate of R0 resection was 46%. Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with R0 resection (odds ratio [OR] 1.90; p = 0.024). Although immediate post-CSP bleeding occurred in 19 polyps (4.8%), no delayed bleeding or perforation was observed. Multivariate analysis revealed protruded lesion as an independent risk factor for immediate bleeding (OR 3.54; p = 0.018).
A higher rate of R0 resection with CSP can be achieved by performing colonoscopy with NBI-M, than with white-light imaging. Macroscopic protruding appearance of a polyp is a risk factor for immediate bleeding.
冷圈套息肉切除术（CSP）的疗效和安全性相关因素尚未得到充分证实。本研究旨在阐明 CSP 达到完全切除（R0）和即刻出血的预测因素。
我们回顾性分析了日本东京大学医院接受 CSP 治疗亚厘米大小息肉的患者数据库。利用患者和息肉的特征数据，如位置、大小和大体外观；使用窄带成像放大技术（NBI-M）；以及内镜医师的经验，我们通过单因素和多因素分析揭示了与 R0 切除和即刻 CSP 出血相关的预测因素。
共切除了 200 例无抗栓药物患者的 399 个息肉，其中 4%的切除标本未能获得组织。未观察到黏膜内癌。总体 R0 切除率为 46%。多因素分析表明，使用 NBI-M 观察息肉是与 R0 切除相关的独立预测因素（比值比 [OR] 1.90；p = 0.024）。尽管 19 个息肉（4.8%）发生了即刻 CSP 后出血，但未观察到迟发性出血或穿孔。多因素分析显示，突出病变是即刻出血的独立危险因素（OR 3.54；p = 0.018）。
与白光成像相比，使用 NBI-M 行结肠镜检查可提高 CSP 的 R0 切除率。息肉的大体突出外观是即刻出血的危险因素。
