Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E712-E718
DOI: 10.1055/a-1793-9439
Original article

Prospective multicenter study of the efficacy and safety of cold forceps polypectomy for ≤ 6-mm non-ampullary duodenal low-grade adenomas

Hiromitsu Kanzaki
 1   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Joichiro Horii
 2   Department of Gastroenterology, Fukuyama Medical Center, Hiroshima, Japan
,
Ryuta Takenaka
 3   Department of Internal Medicine, Tsuyama Central Hospital, Okayama, Japan
,
Hiroyuki Nakagawa
 4   Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
,
Kazuhiro Matsueda
 5   Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
,
Takao Tsuzuki
 6   Department of Internal Medicine, Himeji Red Cross Hospital, Hyogo, Japan
,
Masahide Kita
 7   Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
,
Yasushi Yamasaki
 1   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Takehiro Tanaka
 8   Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Masaya Iwamuro
 1   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Seiji Kawano
 1   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
Yoshiro Kawahara
 9   Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
,
Jun Tomoda
10   Department of Internal Medicine, Akaiwa Medical Association Hospital, Okayama, Japan
,
Hiroyuki Okada
 1   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
› Author AffiliationsTRIAL REGISTRATION: Multi-Center, Single arm, prospective trial at https://upload.umin.ac.jp
› Further Information
Also available at
   Permissions and Reprints

Referred to by:

Methods to obtain informed consent in medical and biological research involving human subject: application to studies on digestive endoscopyEndosc Int Open 2022; 10(06): E719-E720
DOI: 10.1055/a-1776-7801

Corrected by:

Prospective multicenter study of the efficacy and safety of cold forceps polypectomy for ≤ 6-mm non-ampullary duodenal low-grade adenomasEndosc Int Open 2022; 10(06): C6-C6
DOI: 10.1055/a-1895-1758

Abstract

Background and study aims Because the endoscopic treatment for non-ampullary duodenal adenoma (NADA) has a non-negligible risk of adverse events (AEs), a safe and easy treatment for NADA is desirable. This was a multicenter prospective trial evaluating the efficacy and safety of cold forceps polypectomy (CFP) for diminutive NADAs.

Patients and methods This study was prospectively conducted at six general hospitals and one university hospital. The inclusion criteria were histologic and endoscopic diagnosis of low-grade NADA measuring ≤ 6 mm. A second endoscopy was scheduled for 1 month after CFP. After confirmation of the success of CFP, 6-month and 12-month surveillance endoscopies were scheduled. The primary endpoint was the endoscopic and histologic disease disappearance rates at the 12-month endoscopy.

Results Thirty-nine lesions from 38 patients were prospectively included. Median tumor size at enrollment was 5 mm (range 3–6 mm). There were four cases of remnant lesions at the second endoscopy, and the lesion disappearance rate of single CFP was 89.7 % (35 /39; 95 % confidence interval (CI), 76.9 %–97.9 %). In three cases, complete removal of the lesion was achieved with a single re-CFP, but one case required four repeat CFPs. The lesion disappearance rate at 12-month endoscopy was 97.4 % (38 /39; 95 %CI, 86.8 %–99.5 %). During the follow-up period, no AEs related to CFP were observed.

Conclusions CFP for NADA ≤ 6 mm was safe and effective in this study. This common endoscopic method to remove lesions may be an option for treatment of diminutive NADAs.



Publication History

Received: 01 September 2021

Accepted after revision: 20 December 2021

Article published online:
10 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Matsueda K, Kanzaki H, Matsueda K. et al. The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. J Gastroenterol Hepatol 2019; 34: 1540-1544
    CrossrefPubMedGoogle Scholar




  • 2 Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W. et al. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open 2018; 6: E998-E1007
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Nonaka S, Oda I, Tada K. et al. Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 2015; 47: 129-135
    PubMedGoogle Scholar
  • 4 Kakushima N, Yoshida M, Yabuuchi Y. et al. Present status of endoscopic submucosal dissection for non-ampullary duodenal epithelial tumors. Clin Endosc 2020; DOI: 10.5946/ce.2019.18.
    CrossrefPubMedGoogle Scholar
  • 5 Fukuhara S, Kato M, Iwasaki E. et al. Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors. Gastrointest Endosc 2020; 91: 1129-1137
    CrossrefPubMedGoogle Scholar
  • 6 Zou J, Chai N, Linghu E. et al. Clinical outcomes of endoscopic resection for non-ampullary duodenal laterally spreading tumors. Surg Endosc 2019; 33: 4048-4056
    CrossrefPubMedGoogle Scholar
  • 7 Hoteya S, Yahagi N, Iizuka T. et al. Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma/adenoma of the duodenum: feasibility and long-term outcomes. Endosc Int Open 2013; 1: 2-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: A hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
    CrossrefPubMedGoogle Scholar
  • 9 Hasegawa H, Bamba S, Takahashi K. et al. Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: A prospective study. Intest Res 2019; 17: 265-272
    CrossrefPubMedGoogle Scholar
  • 10 O’Connor SA, Brooklyn TN, Dunckley PD. et al. High complete resection rate for pre-lift and cold biopsy of diminutive colorectal polyps. Endosc Int Open 2018; 6: E173-E178
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol 2013; 108: 1593-1600
    CrossrefPubMedGoogle Scholar
  • 12 Huh CW, Kim JS, Choi HH. et al. Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: A prospective randomized controlled trial. Gastrointest Endosc 2019; 90: 105-111
    CrossrefPubMedGoogle Scholar
  • 13 Aslan F, Cekiç C, Camci M. et al. What is the most accurate method for the treatment of diminutive colonic polyps? Standard versus Jumbo forceps polypectomy. Med 2015; 94: e621
    CrossrefPubMedGoogle Scholar
  • 14 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
    CrossrefPubMedGoogle Scholar
  • 15 Maruoka D, Matsumura T, Kasamatsu S. et al. Cold polypectomy for duodenal adenomas: A prospective clinical trial. Endoscopy 2017; 49: 776-783
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kakushima N, Ono H, Takao T. et al. Method and timing of resection of superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2014; 26: 35-40
    CrossrefPubMedGoogle Scholar
  • 17 Kanzaki H, Matsueda K, Nakagawa N. et al. Clinical characteristics and course of sporadic non-ampullary duodenal adenomas: A multicentre retrospective study. Med 2021; 100: e27382
    CrossrefPubMedGoogle Scholar
  • 18 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
    Google Scholar
  • 19 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1095-1129
    Google Scholar
  • 20 Kinoshita S, Nishizawa T, Ochiai Y. et al. Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma. Gastrointest Endosc 2017; 86: 329-332
    CrossrefPubMedGoogle Scholar
  • 21 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
    CrossrefPubMedGoogle Scholar
  • 22 Shimodate Y, Mizuno M, Takezawa R. et al. Safety of cold polypectomy for small colorectal neoplastic lesions: A prospective cohort study in Japan. Int J Colorectal Dis 2017; 32: 1261-1266
    CrossrefPubMedGoogle Scholar
  • 23 Takinami M, Kakushima N, Yoshida M. et al. Endoscopic features of submucosal invasive non-ampullary duodenal carcinomas. J Gastroenterol Hepatol 2020; 35: 821-826
    CrossrefPubMedGoogle Scholar
  • 24 Kudo S, Kashida H, Tamura T. Early colorectal cancer: Flat or depressed type. J Gastroenterol Hepatol 2000; 15: 66-70
    CrossrefPubMedGoogle Scholar
  • 25 Goda K, Kikuchi D, Yamamoto Y. et al. Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series. Dig Endosc 2014; 26: 23-29
    CrossrefPubMedGoogle Scholar
  • 26 Yamasaki Y, Takeuchi Y, Kanesaka T. et al. Differentiation between duodenal neoplasms and non-neoplasms using magnifying narrow-band imaging - Do we still need biopsies for duodenal lesions?. Dig Endosc 2020; 32: 84-95
    Google Scholar
  • 27 Tsuji S, Doyama H, Tsuji K. et al. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy. World J Gastroenterol 2015; 21: 11832-11841
    CrossrefPubMedGoogle Scholar
  • 28 Yamasaki Y, Uedo N, Akamatsu T. et al. Nonrecurrence rate of underwater EMR for ≤ 20-mm nonampullary duodenal adenomas: A multicenter prospective study (D-UEMR study. Clin Gastroenterol Hepatol 2021; S1542-3565
    PubMedGoogle Scholar