Endoscopy 2018; 50(07): 693-700
DOI: 10.1055/s-0043-124869
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Residual adenoma after cold snare polypectomy for small colorectal adenomas: a prospective clinical study

Daisuke Maruoka
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
2  Clinical Research Center, Chiba University Hospital, Chiba, Japan
,
Makoto Arai
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
3  Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
,
Naoki Akizue
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
3  Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
,
Kentaro Ishikawa
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Shingo Kasamatsu
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Takashi Taida
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Hideaki Ishigami
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Kenichiro Okimoto
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
3  Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
,
Keiko Saito
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Tomoaki Matsumura
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Tomoo Nakagawa
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Tatsuro Katsuno
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
,
Naoya Kato
1  Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
› Author Affiliations
TRIAL REGISTRATION: Single-Center, Single-Arm, prospective trial UMIN000016824 at http://www.umin.ac.jp.
Further Information

Publication History

submitted 20 July 2017

accepted after revision 16 November 2017

Publication Date:
07 February 2018 (eFirst)

Abstract

Background Endoscopic resection of all colonic adenomas prevents the occurrence of colon cancer and death. The European Society of Gastrointestinal Endoscopy Clinical Guideline recommends resection of all polyps predicted to be adenomas and cold snare polypectomy (CSP) for removal of adenomas ≤ 9 mm on the basis of safety; however, it also states that this recommendation lacks adequate evidence of efficacy. The residual adenoma rate after resection is an important indicator of efficacy, but there have been no reports showing this prospectively. Therefore, we aimed to investigate the residual adenoma rate after CSP of small colonic polyps.

Methods Between March 2015 and April 2017, patients who were endoscopically diagnosed with colorectal adenomas < 9 mm underwent CSP, the site being marked with endoscopic clips. Patients with pathologically confirmed adenomas underwent follow-up colonoscopy 3 weeks after CSP and any post-CSP scars were biopsied. The primary endpoint was the presence of pathological residual adenoma 3 weeks after CSP.

Results Overall, 126 lesions in 39 patients were removed and 125 (99.2 %) were resected en bloc using CSP. Pathologically, 111 lesions (88.1 %) were confirmed as adenomas (4.2 ± 1.5 mm), with 36 of these (32.4 %) determined to be R0 resections. No complications were observed. All 37 patients with pathologically confirmed adenomas underwent follow-up colonoscopy, and 102 of 111 scars were detected in 33 patients. One pathological residual adenoma (0.98 %, 95 % confidence interval 0.02 % – 5.3 %) was identified.

Conclusions CSP appears to be an effective treatment for diminutive and small colorectal adenomas, with a low residual adenoma rate.