Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Digestion. 2023;104(5):391-399. doi: 10.1159/000530642. Epub 2023 Jun 16.
Cold snare polypectomy (CSP) is a safe and effective procedure for small colorectal polyps ≤9 mm. There are only limited data regarding CSP of larger neoplastic lesions. This study evaluated the efficacy and safety of CSP for polyps between 10 and 15 mm in size.
In this prospective single-arm observational pilot study, patients with a least one polyp 10-15 mm were included. These polyps were preferably removed by CSP using a dedicated hybrid snare. The primary outcome was the histological complete resection rate (CRR) determined by pathologically negative margins of the specimen and no neoplastic tissue obtained from biopsies of the resection site margin. Secondary outcomes were en bloc resection rate, failure of CSP, and incidence of adverse events.
A total of 61 neoplastic polyps were removed from 39 patients. Overall CRR was 80.3% (49/61). CSP was feasible in 78.7% (48/61) of polyps and the CRR in this group was 85.4% (41/48). When CSP failed (13/61; 21.3%), lesions were successfully resected by immediate HSP using the same snare with a CRR of 61.5% (8/13) in this group. One patient presented delayed hemorrhage after HSP of a polyp but successful hemostasis was achieved with two hemoclips. No other adverse events occurred. No recurrence was seen on follow-up colonoscopy in cases with incomplete resected polyps.
CSP seems to be efficient and safe in removing colorectal polyps up to 15 mm. A hybrid snare seems to be particularly advantageous for these polyps as it allows immediate conversion to HSP if CSP might fail in larger polyps. This trial is registered at ClinicalTrials.gov (NCT04464837).
冷圈套息肉切除术（CSP）是一种安全有效的治疗直径≤9mm 的小结直肠息肉的方法。对于较大的肿瘤性病变，CSP 的相关数据有限。本研究评估了 CSP 切除 10-15mm 大小息肉的疗效和安全性。
在这项前瞻性单臂观察性研究中，纳入至少有一个 10-15mm 大小息肉的患者。这些息肉最好使用专用的混合圈套器进行 CSP 切除。主要终点是通过标本的病理阴性边缘和切除部位边缘活检未获得肿瘤组织来确定的组织学完全切除率（CRR）。次要终点是整块切除率、CSP 失败率和不良事件发生率。
从 39 名患者中切除了 61 个肿瘤性息肉。总体 CRR 为 80.3%（49/61）。CSP 可用于 78.7%（48/61）的息肉，该组的 CRR 为 85.4%（41/48）。当 CSP 失败（13/61；21.3%）时，用相同的圈套器立即行 HSP，该组的 CRR 为 61.5%（8/13）。1 例 HSP 切除息肉后出现迟发性出血，但用两个止血夹成功止血。其他无不良事件发生。在不完全切除息肉的病例中，在随访结肠镜检查时未发现复发。
CSP 切除直径达 15mm 的结直肠息肉似乎是有效且安全的。对于这些息肉，混合圈套器似乎特别有利，因为如果 CSP 可能在较大的息肉中失败，可以立即转换为 HSP。本试验在 ClinicalTrials.gov（NCT04464837）注册。
