Zachou Maria, Nifora Martha, Androutsakos Theodoros, Katsaras Georgios, Varytimiadis Konstantinos, Zoumpouli Christina, Karantanos Panayiotis, Lalla Efthimia, Mpetsios Georgios, Panoutsakou Maria, Stoica Roxana, Thermou Dionisia, Mavrogenis Georgios, Ntikoudi Evangelia, Nikiteas Nikolaos, Sougioultzis Stavros, Kalaitzakis Evangelos, Kykalos Stilianos
Second Department of Propaedeutic Surgery, "Laikon" General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica).
Department of Gastroenterology, "Sismanogleio" General Hospital, Athens (Maria Zachou, Nikolaos Nikiteas, Stilianos Kykalos).
Ann Gastroenterol. 2024 Jul-Aug;37(4):466-475. doi: 10.20524/aog.2024.0889. Epub 2024 Jun 14.
The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety.
This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for non-pedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, resection rate, adverse events, and recurrence rate.
The COLDWATER study found higher resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than non-experts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels.
UCSP achieves a more extensive excision of the compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection.
传统冷圈套息肉切除术（CCSP）的R0切除率（R0RR）和不完全切除率（IRR）范围较广，这凸显了技术改进的必要性。COLDWATER研究旨在比较水下冷圈套息肉切除术（UCSP）与CCSP用于治疗5-10毫米结直肠息肉的效果，重点关注全面的组织病理学评估、疗效和安全性。
这是一项随机、单盲、对照试验，比较UCSP与CCSP治疗直径5-10毫米的无蒂结直肠息肉的效果。主要结局是报告切除率的差异。次要结局重点关注切除深度、R0-RR、IRR、切除率、不良事件和复发率的差异。
COLDWATER研究发现，UCSP的切除率更高（81.72±62.81% vs. CCSP：72.33±22.33%，P=0.003），黏膜下层存在情况相当（UCSP：16.6%，CCSP：12.5%，P=0.25）。UCSP在IRR（3.5% vs. 8.5%，P=0.05）和切除率（98% vs. 93.5%，P=0.04）方面显示出更好的结果。在CCSP中，专家内镜医师的R0RR高于非专家，而UCSP在不同内镜医师经验水平下的R0RR无显著差异。
与CCSP相比，UCSP能实现更广泛的切除，尽管其切除深度未更深。此外，UCSP显示出更高的切除率，IRR更低，并且鉴于其在实现R0切除方面与经验无关的成功率，它成为培训无经验内镜医师进行息肉切除术的一种有前景的技术。
