CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(07): E812-E820
DOI: 10.1055/a-0607-0727
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Polypectomy techniques among gastroenterologists in Norway – a nationwide survey

Ina B. Pedersen
1   Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
,
Magnus Løberg
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3   Department of Transplantation Medicine and K. G. Jebsen Colorectal Cancer Research Center, Oslo University Hospital, Oslo, Norway
,
Geir Hoff
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3   Department of Transplantation Medicine and K. G. Jebsen Colorectal Cancer Research Center, Oslo University Hospital, Oslo, Norway
4   Department of research, Telemark Hospital, Skien, Norway
5   Cancer Registry of Norway, Oslo, Norway
,
Mette Kalager
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3   Department of Transplantation Medicine and K. G. Jebsen Colorectal Cancer Research Center, Oslo University Hospital, Oslo, Norway
,
Michael Bretthauer
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
3   Department of Transplantation Medicine and K. G. Jebsen Colorectal Cancer Research Center, Oslo University Hospital, Oslo, Norway
6   Frontier Science, Boston, Massachusetts, United States
,
Øyvind Holme
1   Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
2   Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
› Author Affiliations
Further Information

Publication History

submitted 14 December 2017

accepted after revision 19 March 2018

Publication Date:
04 July 2018 (online)

Abstract

Background and study aims Incomplete polyp removal has been estimated to cause 27 % of all colorectal cancers detected soon after colonoscopy. There is limited information regarding polypectomy techniques among endoscopists. The article is a nationwide survey of polypectomy techniques among Norwegian endoscopists.

Materials and methods We invited all board-certified gastroenterologists in Norway to complete a web-based questionnaire about their polypectomy technique. Inadequate polypectomy techniques were defined as using biopsy forceps for polyps larger than 3 mm in diameter, using hot biopsy forceps for polypectomy, and using the same electrocautery output irrespective of polyp size and morphology.

Results Twenty-six of 30 Norwegian gastroenterology departments participated in the study. A total of 119 endoscopists received the survey, and 70 (59 %) responded. Mean duration of endoscopy practice was 11.5 years, and 95 % had performed more than 1,000 colonoscopies during their career. Twenty-eight endoscopists (40 %) used one or more inadequate polypectomy techniques: 10 (14.3 %) used biopsy forceps for removal of polyps larger than 3 mm in diameter, five (7.1 %) used hot biopsy for polypectomy, and 17 (24 %) used the same electrocautery output for all polypectomies. Five (7 %) endoscopists reported that they did not remove polyps smaller than 4 mm.

Conclusion A substantial number of Norwegian endoscopists use inadequate polypectomy techniques. Improved training and certification of endoscopists is warranted.

 
  • References

  • 1 Favoriti P, Carbone G, Greco M. et al. Worldwide burden of colorectal cancer: a review. Updates Surgery 2016; 68: 7-11
  • 2 Svensson E, Grotmol T, Hoff G. et al. Trends in colorectal cancer incidence in Norway by gender and anatomic site: an age-period-cohort analysis. Europ J Cancer Prev 2002; 11: 489-495
  • 3 Holme O, Loberg M, Kalager M. et al. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: a randomized clinical trial. JAMA 2014; 312: 606-615
  • 4 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
  • 5 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.e71
  • 6 Efthymiou M, Taylor AC, Desmond PV. et al. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy 2011; 43: 312-316
  • 7 Robertson DJ, Lieberman DA, Winawer SJ. et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63: 949-956
  • 8 Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management. Gastrointest Endosc Clin North Am 2010; 20: 659-671
  • 9 Carter D, Beer-Gabel M, Zbar A. et al. A survey of colonoscopic polypectomy practice amongst Israeli gastroenterologists. Ann Gastroenterol 2013; 26: 135-140
  • 10 Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc 2004; 60: 414-418
  • 11 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
  • 12 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
  • 13 Mulder SA, Ouwendijk RJ, van Leerdam ME. et al. A nationwide survey evaluating adherence to guidelines for follow-up after polypectomy or treatment for colorectal cancer. J Clin Gastroenterol 2008; 42: 487-492
  • 14 Krist AH, Jones RM, Woolf SH. et al. Timing of repeat colonoscopy: disparity between guidelines and endoscopists' recommendation. Am J Prev Med 2007; 33: 471-478
  • 15 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
  • 16 Kaminski MF, Regula J, Kraszewska E. et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
  • 17 Vleugels JLA, Hazewinkel Y, Fockens P. et al. Natural history of diminutive and small colorectal polyps: a systematic literature review. Gastrointest Endosc 2017; 85: 1169-1176.e1161
  • 18 Kuiper T, Marsman WA, Jansen JM. et al. Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings. Clin Gastroenterol Hepatol 2012; 10: 1016-1020 ; quiz e1079
  • 19 Patel SG, Schoenfeld P, Kim HM. et al. Real-time characterization of diminutive colorectal polyp histology using narrow-band imaging: implications for the resect and discard strategy. Gastroenterology 2016; 150: 406-418
  • 20 Murino A, Hassan C, Repici A. The diminutive colon polyp: biopsy, snare, leave alone?. Curr Opin Gastroenterol 2016; 32: 38-43
  • 21 Komeda Y, Kashida H, Sakurai T. et al. Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy. World J Gastroenterol 2017; 23: 328-335
  • 22 Peluso F, Goldner F. Follow-up of hot biopsy forceps treatment of diminutive colonic polyps. Gastrointest Endosc 1991; 37: 604-606
  • 23 Ko CW, Riffle S, Michaels L. et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol 2010; 8: 166-173
  • 24 Dyer WS, Quigley EM, Noel SM. et al. Major colonic hemorrhage following electrocoagulating (hot) biopsy of diminutive colonic polyps: relationship to colonic location and low-dose aspirin therapy. Gastrointest Endosc 1991; 37: 361-364
  • 25 Gilbert DA, DiMarino AJ, Jensen DM. et al. Status evaluation: hot biopsy forceps. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee. Gastrointest Endosc 1992; 38: 753-756
  • 26 Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol 1995; 90: 24-28
  • 27 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
  • 28 Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastroenterol Clin North Am 2008; 37: 229-251, ix
  • 29 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
  • 30 Liu S, Ho SB, Krinsky ML. Quality of polyp resection during colonoscopy: are we achieving polyp clearance?. Digest Dis Sci 2012; 57: 1786-1791
  • 31 Kreft i tykktarm og endetarm – handlingsprogram. 2015 The Norwegian Directory of Health
  • 32 Association TNM. Oversikt over godkjente spesialister i gastroenterologi/Board certified gastroenterologists. The Norwegian Medical Association. 2017
  • 33 Johnson TP, Wislar JS. Response rates and nonresponse errors in surveys. Jama 2012; 307: 1805-1806