Department of Gastroenterology, Asahikawa-Kousei General Hospital.
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University.
Medicine (Baltimore). 2021 Jun 11;100(23):e26296. doi: 10.1097/MD.0000000000026296.
Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy.
Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate.
A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06).
Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.
冷圈套息肉切除术（CSP）切除小的结直肠息肉的安全性与热圈套息肉切除术（HSP）相当。CSP 的有效性尚未明确，长期复发的发生率也尚未确定。我们进行了一项随机对照研究和为期一年的随访研究，以评估其安全性和有效性。
将小的结直肠息肉患者随机分为 CSP 组或 HSP 组。行息肉切除术以确定病理治愈性，并让患者完成关于手术耐受性的问卷调查。行结肠镜随访以确定腺瘤的局部复发情况。主要结局是 CSP 与 HSP 在迟发性出血率方面的非劣效性，次要结局包括即时出血和穿孔发生率、手术时间和切除率。
本随机研究共纳入 119 例患者并进行了息肉切除术。在 458 个息肉中，分析了 332 个符合条件的息肉。CSP 的不良事件发生率为 0.6%（1/175），HSP 为 0%（0/157），表明 CSP 具有非劣效性。虽然 CSP 的完全切除率非常高（100%），但 R0 率并不理想（水平切缘，65.5%；垂直切缘，89.1%）。在 80 个接受 CSP 治疗的腺瘤的随访中观察到 2 个局部复发（2.5%）。HSP 组 79 个病变中未发现复发，差异无统计学意义（P = .06）。
CSP 可安全切除结直肠息肉，与 HSP 相似。大多数人会认为 CSP 比 HSP 更安全。那么主要的问题就与疗效有关。我们本研究的结果表明，CSP 后复发应谨慎处理以进行根治性治疗。
