Endoscopy 2018; 50(04): 403-411
DOI: 10.1055/s-0043-118594
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial

Vasilios Papastergiou
1  Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece
,
Konstantina D. Paraskeva
1  Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece
,
Maria Fragaki
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Ioannis Dimas
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Emmanouil Vardas
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Angeliki Theodoropoulou
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Nicoletta Mathou
1  Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece
,
Athanasios Giannakopoulos
1  Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece
,
Konstantinos Karmiris
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Afroditi Mpitouli
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
,
Dimitra Apessou
3  Department of Histopathology, Konstantopouleio General Hospital, Athens, Greece
,
Linda Giannikaki
4  Department of Histopathology, Venizeleio General Hospital, Heraklion, Greece
,
John A. Karagiannis
1  Department of Gastroenterology, Konstantopouleio General Hospital, Athens, Greece
,
Grigorios Chlouverakis
5  Department of Social Medicine, University of Crete, Medical College, Heraklion, Greece
,
Gregorios A. Paspatis
2  Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
› Author Affiliations
TRIAL REGISTRATION: Dual-Center, Randomized, Prospective Trial NCT02678663 at clinicaltrials.gov
Further Information

Publication History

submitted 08 May 2017

accepted after revision 04 August 2017

Publication Date:
12 September 2017 (eFirst)

Abstract

Background and study aims Cold snare polypectomy is an established method for the resection of small colorectal polyps; however, significant incomplete resection rates still leave room for improvement. We aimed to assess the efficacy of cold snare endoscopic mucosal resection (CS-EMR), compared with hot snare endoscopic mucosal resection (HS-EMR), for nonpedunculated polyps sized 6 – 10 mm.

Patients and methods This study was a dual-center, randomized, noninferiority trial. Consecutive adult patients with at least one nonpedunculated polyp sized 6 – 10 mm were enrolled. Eligible polyps were randomized (1:1) to be treated with either CS-EMR or HS-EMR. Both methods involved submucosal injection of a methylene blue-tinted normal saline solution. The primary noninferiority end point was histological eradication evaluated by postpolypectomy biopsies (noninferiority margin – 10 %). Secondary outcomes included occurrence of intraprocedural bleeding, clinically significant postprocedural bleeding, and perforation.

Results Among 689 patients screened, 155 patients with 164 eligible polyps were included (CS-EMR n = 83, HS-EMR n = 81). The overall rate of histological complete resection was 92.8 % in the CS-EMR group and 96.3 % in the HS-EMR group (difference 3.5 %; 95 % confidence interval [CI] – 4.15 to 11.56), showing noninferiority of CS-EMR compared with HS-EMR. CS-EMR was shown to be noninferior both for polyps measuring 6 – 7 mm (CS-EMR 93.3 %; HS-EMR 100 %; 95 %CI – 7.95 to 21.3) and those of 8 – 10 mm (92.5 % vs. 94.7 %, respectively; 95 %CI – 7.91 to 13.16). Rates of intraprocedural bleeding were similar between the two groups (CS-EMR 3.6 %, HS-EMR 1.2 %; P  = 0.30). No clinically significant postprocedural bleeding or perforation occurred in either group.

Conclusions CS-EMR appears to be a valuable modification of the standard cold snare technique, obviating the need to use diathermy for nonpedunculated colorectal polyps sized 6 – 10 mm.