Endoscopy 2019; 51(03): 253-260
DOI: 10.1055/a-0833-8548
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Local recurrence of diminutive colorectal polyps after cold forceps polypectomy with jumbo forceps followed by magnified narrow-band imaging: a multicenter prospective study

Toshio Kuwai
1  Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
,
Takuya Yamada
2  Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
,
Tatsuya Toyokawa
3  Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
,
Hiroaki Iwase
4  Department of Gastroenterology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
,
Tomohiro Kudo
5  Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
,
Naoki Esaka
6  Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
,
Hajime Ohta
7  Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
,
Haruhiro Yamashita
8  Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
,
Yasuo Hosoda
9  Department of Gastroenterology, National Hospital Organization Saitama National Hospital, Saitama, Japan
,
Noriko Watanabe
10  Department of Gastroenterology, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
,
Naohiko Harada
11  Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
› Author Affiliations
TRIAL REGISTRATION: a multicenter prospective study UMIN000015969 at University Hospital Medical Network Clinical Trials Registry
Further Information

Publication History

submitted 13 September 2018

accepted after revision 01 January 2019

Publication Date:
23 January 2019 (eFirst)

Background Cold polypectomy has been increasingly used to remove diminutive colorectal polyps. We evaluated the local recurrence rate of diminutive polyps at the 1-year follow-up after cold forceps polypectomy (CFP).

Methods In a prospective, multicenter, observational cohort study, patients with diminutive colorectal polyps ( ≤ 5 mm) were treated by CFP using jumbo forceps followed by magnified narrow-band imaging (NBI). Patients were assessed for local recurrence at 1-year follow-up. Risk factors associated with local recurrence were analyzed using logistic regression analysis.

Results Overall, 955 lesions were resected in 471 patients who completed the 1-year follow-up. The endoscopic complete resection rate was 99.4 %. Immediate and delayed bleeding occurred in 0.8 % and 0.2 % of cases, respectively, with no perforations observed. Local recurrence occurred in 2.1 % of cases at the 1-year follow-up. Univariable analyses indicated that polyps > 3 mm (P < 0.01) and immediate bleeding (P = 0.04) were significantly associated with local recurrence. A trend was observed for patients ≥ 65 years (P = 0.06) and fractional resection (P = 0.09). Multivariable analyses confirmed that lesions > 3 mm were significantly associated with local recurrence (odds ratio 3.4, P = 0.02).

Conclusions CFP with jumbo forceps followed by NBI-magnified observation had a low local recurrence rate and is an acceptable therapeutic option for diminutive colorectal polyps. Although we recommend limiting the use of CFP with jumbo forceps to polyps ≤ 3 mm in size, future comparative studies are needed to make recommendations on cold polypectomy using either forceps or snares as the preferred approach for diminutive polyp resection.