Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
Am J Gastroenterol. 2022 Jan 1;117(1):100. doi: 10.14309/ajg.0000000000001554.
Cold snare polypectomy (CSP) is safe and effective for the removal of small adenomas (≤10 mm); however, reported incomplete resection rates (IRRs) vary. The optimal CSP technique, where a wide margin of normal tissue is resected around the target lesion, and snare design have both been hypothesized to reduce the IRR after CSP. We sought to investigate the efficacy of a thin-wire versus thick-wire diameter snare on IRR, using the standardized CSP technique.
This was an international multicenter parallel design randomized trial with 17 endoscopists of varying experience (NCT02581254). Patients were randomized in a 1:1 ratio to the use of a thin-wire (0.30 mm) or thick-wire (0.47 mm) snare for CSP of small (≤10 mm) colorectal polyps. The primary end point was the IRR as determined by the histologic assessment of the defect margin after polypectomy.
Over 52 months to January 2020, 1,393 patients were eligible. A total of 660 patients with polyps (57.4% male) were randomized to a thin-wire (n = 339) or thick-wire (n = 321) snare. The overall IRR of the cohort was 1.5%. There was no significant difference in the IRR between the thin- and thick-wire arms; relative risk-0.41, 95% CI (0.11-1.56), P = 0.21. No significant differences were observed in the rate of adverse events.
In this multicenter randomized trial, CSP is safe and effective with very low rates of incomplete resection independent of the diameter of the snare wire used. This suggests that the optimal operator technique is more important than the snare design alone in minimizing residual adenoma after CSP.
冷圈套息肉切除术（CSP）对于切除小腺瘤（≤10mm）是安全且有效的；然而，报道的不完全切除率（IRR）有所不同。假设通过优化 CSP 技术，在目标病变周围切除正常组织的宽边缘，并设计圈套，都可以降低 CSP 后的 IRR。我们旨在研究使用标准化 CSP 技术时，细径（0.30mm）和粗径（0.47mm）圈套在 IRR 上的效果。
这是一项国际性、多中心、平行设计的随机试验，有 17 位经验不同的内镜医生参与（NCT02581254）。患者以 1:1 的比例随机分为细径（0.30mm）或粗径（0.47mm）圈套组，进行小（≤10mm）结直肠息肉的 CSP。主要终点是通过息肉切除后的组织学评估确定的 IRR。
截至 2020 年 1 月的 52 个月期间，共有 1393 名患者符合条件。共有 660 名（57.4%为男性）患有息肉的患者被随机分为细径（n=339）或粗径（n=321）圈套组。该队列的总体 IRR 为 1.5%。细径和粗径圈套组之间的 IRR 无显著差异；相对风险 0.41，95%CI（0.11-1.56），P=0.21。未观察到不良事件发生率的显著差异。
在这项多中心随机试验中，CSP 是安全有效的，且不完全切除率非常低，与使用的圈套线直径无关。这表明，在 CSP 后尽量减少残留腺瘤方面，最佳的操作者技术比圈套设计本身更为重要。
