Validation of treatment algorithm based on the Japan narrow-band imaging expert team classification for sub-centimeter colorectal polyps

Motohiko Kato; Keiichiro Abe; Yoko Kubosawa; Yukie Sunata; Yuichiro Hirai; Tetsu Hirata; Yoshiaki Takada; Michiko Wada; Yusaku Takatori; Shigeo Banno; Satoshi Kinoshita; Hideki Mori; Kaoru Takabayashi; Masahiro Kikuchi; Junichi Shiraishi; Toshio Uraoka

doi:10.1055/a-0621-4445

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E934-E940
DOI: 10.1055/a-0621-4445

Original article

Validation of treatment algorithm based on the Japan narrow-band imaging expert team classification for sub-centimeter colorectal polyps

Motohiko Kato

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Keiichiro Abe

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Yoko Kubosawa

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Yukie Sunata

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Yuichiro Hirai

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Tetsu Hirata

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Yoshiaki Takada

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Michiko Wada

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Yusaku Takatori

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Shigeo Banno

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Satoshi Kinoshita

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Hideki Mori

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Kaoru Takabayashi

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Masahiro Kikuchi

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Junichi Shiraishi

²Department of Pathology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

,

Toshio Uraoka

¹Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

› Author Affiliations

Abstract

Background and study aims Although cold polypectomy (CP) is widely used for colorectal polyps < 10 mm, appropriateness of indications for CP or endoscopic mucosal resection (EMR) are still unclear. The aim of this study was to validate the endoscopic treatment algorithm based on the Japan NBI Expert Team (JNET) classification.

Patients and methods Consecutive patients with at least one colorectal non-pedunculated polyp < 10 mm between July 2014 and October 2016 were included in this retrospective study. During the period, EMR was performed for JNET ≥ 2B lesions and CP for JNET < 2A. Among a total of 3966 lesions, 3368 lesions with JNET ≤ 2A were resected by CP in compliance with the treatment algorithm but 565 resections for JNET ≤ 2A were not compliant (by EMR), while all 24 JNET > 2B lesions were removed by EMR in compliance with the algorithm. Polypectomy outcomes were compared between the compliant and non-compliant groups. Histological outcomes were analyzed in accordance with JNET classification.

Results Post-polypectomy bleeding rate in the compliant group (0 %) was lower than that in the non-compliant group (0.53 %, P < 0.01). Proportion of lesions diagnosed as cancer (38 % vs 0.36 %, P < 0.01) or submucosal cancer (4.2 % vs 0.03 %, P = 0.012), and the lesion with free resection margin (91 % vs 64 %, P < 0.01) was higher in the JNET ≥ 2B than JNET ≤ 2A.

Conclusion This study indicated our algorithm would be valid: CP is suitable for most polyps < 10 mm as incidence of post-polypectomy bleeding is low, whereas EMR is recommended for JNET ≥ 2B lesions for histological complete removal.

Full Text

References

References
1 WHO. World Cancer Research Fund International. 2012
2 Cho KR, Vogelstein B. Suppressor gene alterations in the colorectal adenoma-carcinoma sequence. Journal of cellular biochemistry Supplement 1992; 16G: 137-141
3 Deyhle P. A method for endoscopic electroresection of sessile colonoc polyps. Endoscopy 1973; 5: 38-40
4 Wolff WI, Shinya H. Polypectomy via the fiberoptic colonoscope. Removal of neoplasms beyond reach of the sigmoidoscope. N Engl J Med 1973; 288: 329-332
5 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
6 Atkin WS, Edwards R, Kralj-Hans I. et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet (London, England) 2010; 375: 1624-1633
7 Fisher DA, Maple JT. Committee ASoP. et al. Complications of colonoscopy. Gastrointest Endosc 2011; 74: 745-752
8 Woods A, Sanowski RA, Wadas DD. et al. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. Gastrointest Endosc 1989; 35: 536-540
9 Draganov PV, Chang MN, Alkhasawneh A. et al. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointestinal Endoscopy 2012; 75: 118-126
10 Tappero G, Gaia E, De Giuli P. et al. Cold snare excision of small colorectal polyps. Gastrointest Endosc 1992; 38: 310-313
11 Raad D, Tripathi P, Cooper G. et al. Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83: 508-515
12 Uraoka T, Ramberan H, Matsuda T. et al. Cold polypectomy techniques for diminutive polyps in the colorectum. Dig Endosc 2014; 26 (Suppl. 02) 98-103
13 Horiuchi A, Nakayama Y, Kajiyama M. et al. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc 2014; 79: 417-423
14 Repici A, Hassan C, Vitetta E. et al. Safety of cold polypectomy for < 10 mm polyps at colonoscopy: a prospective multicenter study. Endoscopy 2011; 44: 27-31
15 Kanao H, Tanaka S, Oka S. et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 2009; 69: 631-636
16 Sano Y, Ikematsu H, Fu KI. et al. Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 2009; 69: 278-283
17 Wada Y, Kudo SE, Kashida H. et al. Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 2009; 70: 522-531
18 Higashi R, Uraoka T, Kato J. et al. Diagnostic accuracy of narrow-band imaging and pit pattern analysis significantly improved for less-experienced endoscopists after an expanded training program. Gastrointest Endosc 2010; 72: 127-135
19 Ikematsu H, Matsuda T, Emura F. et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC gastroenterology 2010; 10: 33
20 Sano Y, Tanaka S, Kudo SE. et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016; 28: 526-533
21 Fujimoto K, Fujishiro M, Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
22 [Anonymous] Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005; 37: 570-578
23 Stolte M. The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: advantages and disadvantages. Virchows Arch 2003; 442: 99-106
24 Tutticci N, Burgess NG, Pellise M. et al. Characterization and significance of protrusions in the mucosal defect after cold snare polypectomy. Gastrointest Endosc 2015; 82: 523-528
25 Gschwantler M, Kriwanek S, Langner E. et al. High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics. Eur J Gastroenterol Hepatol 2002; 14: 183-188
26 Lieberman D, Moravec M, Holub J. et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 2008; 135: 1100-1105