Efficacy of specimen pasting after cold snare polypectomy for pathological evaluation of horizontal margins

Abstract

Background and study aims Several studies have reported that pathological horizontal margin evaluation cannot be diagnosed in cold snare polypectomy (CSP) specimens. We conducted a prospective randomized controlled trial to determine the efficacy of pasting CSP specimens on paper for pathological horizontal margins.

Patients and methods This was a single-center, prospective study conducted at Osaka Saiseikai Nakatsu Hospital. In this study, the indications for CSP were adenomas ≤ 10 mm. Colorectal polyps resected by CSP were randomized to the pasting and non-pasting groups after exclusion of fragmented specimens, and the extended CSP specimens pasted on paper were formalin-fixed in the pasting group. The primary endpoint was rate of unclear horizontal margins after CSP.

Results A total of 216 CSP specimens were analyzed. The rate of unclear horizontal margins was significantly lower in the pasting group than in the non-pasting group (15.1 % vs 33.6 %, P = 0.002). CSP specimen pasting significantly reduced the rate of unclear horizontal margins. On multivariate analysis, non-pasting group (odds ratio [OR], 2.69; 95 % confidence interval [CI], 1.38–5.41; P = 0.003) and right colon (OR, 1.98; 95 %CI, 1.01–4.01; P = 0.047) were independent risk factors for unclear horizontal margins in CSP specimens.

Conclusions Pasting the extended specimen is important for accurate pathological examination after CSP.

Publication History

Received: 07 December 2021

Accepted: 03 January 2022

Article published online:
13 May 2022

• References

• 1 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
• 2 Zauber AG, Winawer SJ, OʼBrien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 3 Fujiya M, Sato H, Ueno N. et al. Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis. World J Gastroenterol 2016; 22: 5436-5444
• 4 Kawamura T, Takeuchi Y, Asai S. et al. A comparison of the resection rate for cold and hot snare polypectomy for 4-9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67: 1950-1957
• 5 Ichise Y, Horiuchi A, Nakayama Y. et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion 2011; 84: 78-81
• 6 Makino T, Horiuchi A, Kajiyama M. et al. Delayed bleeding following cold snare polypectomy for small colorectal polyps in patients taking antithrombotic agents. J Clin Gastroenterol 2018; 52: 502-507
• 7 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
• 8 Matsuura N, Takeuchi Y, Yamashina T. et al. Incomplete resection rate of cold snare polypectomy: A prospective single-arm observational study. Endoscopy 2017; 49: 251-257
• 9 Arimoto J, Chiba H, Higurashi T. et al. Risk factors for incomplete polyp resection after cold snare polypectomy. Int J Colorectal Dis 2019; 34: 1563-1569
• 10 Takeuchi Y, Yamashina T, Matsuura N. et al. Feasibility of cold snare polypectomy in Japan: A pilot study. World J Gastrointest Endosc 2015; 7: 1250-1256
• 11 Din S, Ball AJ, Riley SA. et al. Cold snare polypectomy: does snare type influence outcomes?. Dig Endosc 2015; 27: 603-608
• 12 Ichihara S, Uraoka T, Oka S. Challenges associated with the pathological diagnosis of colorectal tumors less than 10 mm in size. Dig Endosc 2018; 30: 41-44
• 13 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-Update 2019. Endoscopy 2019; 51: 775-794
• 14 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 15 Ikeda T, Yoshizaki T, Okamura T. et al. Usefulness of pasting of cold snare polypectomy specimens on filterpaper. Japanese J Med Technol 2020; 69: 25-29
• 16 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632
• 17 The Paris endoscopic classification of superficial neoplastic lesions. esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
• 18 Ito A, Suga T, Ota H. et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018; 53: 1171-1178
• 19 Maruoka D, Arai M, Akizue N. et al. Residual adenoma after cold snare polypectomy for small colorectal adenomas: a prospective clinical study. Endoscopy 2018; 50: 693-700
• 20 Hirose R, Yoshida N, Murakami T. et al. Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10-14 mm in diameter. Dig Endosc 2017; 29: 594-601
• 21 Murakami T, Yoshida N, Yasuda R. et al. Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps. Surg Endosc 2020; 34: 2918-2925
• 22 Hiroyuki O, Kenshi Y, Mitsuhiro F. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Digestive Endoscopy 2021; 33: 4-20
• 23 Kim JS, Lee IB, Choi H. et al. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2015; 81: 741-747
• 24 Kishida Y, Hotta K, Imai K. et al. Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis. Dig Endosc 2021; 33: 433-440
• 25 Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 1990; 14: 524-537
• 26 Goldstein NS, Bhanot P, Odishi E. et al. Hyperplastic-like colon polyps that precededmicrosatellite-unstable adenocarcinomas. Am J Clin Pathol 2003; 119: 778-796
• 27 Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 2005; 47: 32-40
• 28 Pohl H, Srivastava A, Bensen SP. et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80