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Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis
submitted 11 November 2015
accepted after revision 12 February 2016
30 March 2016 (online)
Background and study aims: Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP.
Patients and methods: This was a retrospective cohort study. Polyps were counted and the range of polyp size recorded at each examination. Patients with a reduction in polyp number and mean size were considered to have successful endoscopic reduction of their polyp burdens.
Results: Of 79 patients with FAP, 21 had an attempt at delaying surgery by cold snaring of at least 30 adenomas, and had at least one follow-up at our institution. Ten patients had intact colons, 6 had intact rectums, and 5 had heavy polyp burdens in an ileo-anal pouch. Among the 21 patients, the mean number of polyps resected at the first examination was 85, range 30 – 342. Nineteen of 21 patients had fewer polyps at the second examination, and of those, only one had any persistence of adenomas ≥ 1 cm in size. During follow-up, two patients underwent surgical resection and the remainder had reductions in their polyp burdens at follow-up endoscopy.
Conclusions: Cold snare polypectomy effectively reduces polyp burden in selected FAP patients.
- 1 Young Y, Terdiman JP. Endoscopic management of familial colonic neoplasia. Gastrointest Endosc Clin North Am 2005; 15: 549-580
- 2 Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
- 3 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
- 4 Giardiello FM, Hamilton SR, Krush AJ et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis. NEJM 1993; 328: 1313-1316
- 5 Steinbach G, Lynch PM, Phillips RK et al. The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis. NEJM 2000; 342: 1946-1952
- 6 West NJ, Clark SK, Phillips RK et al. Eicosapentaenoic acid reduces rectal polyp number and size in familial adenomatous polyposis. Gut 2010; 59: 918-925
- 7 Cruz-Correa M, Shoskes DA, Sanchez P et al. Combination treatment with curcumin and quercetin of adenomas in familial adenomatous polyposis. Clin Gastroenterol Hepatol 2006; 4: 1035-1038
- 8 Gleeson FC, Papachristou GI, Riegert-Johnson DL et al. Progression to advanced neoplasia is infrequent in post colectomy familial adenomatous polyposis patients under endoscopic surveillance. Fam Cancer 2009; 8: 33-38
- 9 Vasen HF, van Duijvendijk P, Buskens E et al. Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients. Gut 2001; 49: 231-235
- 10 Debinski HS, Love S, Spigelman AD et al. Colorectal polyp counts and cancer risk in familial adenomatous polyposis. Gastroenterology 1996; 110: 1028-1030
- 11 Lynch PM, Morris JS, Ross WA et al. Global quantitative assessment of the colorectal polyp burden in familial adenomatous polyposis by using a web-based tool. Gastrointest Endosc 2013; 77: 455-463