Endoscopy 2011; 43(4): 312-316
DOI: 10.1055/s-0030-1256086
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Biopsy forceps is inadequate for the resection of diminutive polyps

M.  Efthymiou1 , 2 , A.  C.  F.  Taylor1 , P.  V.  Desmond1 , P.  B.  Allen1 , R.  Y.  Chen1
  • 1Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
  • 2University of Melbourne, Melbourne, Australia
Further Information

Publication History

submitted 8 March 2010

accepted after revision 1 October 2010

Publication Date:
16 March 2011 (online)

Background and study aims: Cold biopsy forceps polypectomy (CBP) is often used for the removal of diminutive polyps. The efficacy of the technique has not been thoroughly assessed. The aim of this study was to prospectively assess the efficacy of CBP for removing diminutive polyps.

Patients and methods: This was a prospective study from St Vincent’s Hospital, a tertiary referral hospital in Melbourne, Australia. A total of 143 patients were screened and 52 patients with ≥ 1 diminutive polyps were enrolled. CBP was used to resect diminutive polyps until no polyp tissue was visible. The polyp base was then resected using endoscopic mucosal resection (EMR) with a 1 – 2-mm margin. The CBP and EMR samples were compared to assess completeness of the resection.

Results: Overall 39 % (21 / 54) of diminutive polyps were completely resected using CBP. After binary logistic regression analysis, polyp histology was found to be predictive of resection, with complete resection of 62 % (13 / 21) for adenomas and 24 % (8 / 33) for hyperplastic polyps (odds ratio 5.1; P = 0.008). The size and number of bites taken with the forceps were not predictive of complete response.

Conclusions: Within the limitations of a modest sample size, CBP appears to be inadequate treatment for the removal of diminutive polyps.

References

  • 1 Church J M. Clinical significance of small colorectal polyps.  Dis Colon Rectum. 2004;  47 481-485
  • 2 Kapsoritakis A N, Potamianos S P, Koukourakis M I et al. Diminutive polyps of large bowel should be an early target for endoscopic treatment.  Dig Liver Dis. 2002;  34 137-140
  • 3 Rex D K, Overhiser A J, Chen S C et al. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings.  Am J Gastroenterol. 2009;  104 149-153
  • 4 Weston A P, Campbell D R. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications.  Am J Gastroenterol. 1995;  90 24-28
  • 5 Pines A, Bat L, Rosenbaum J et al. Are tiny polyps important when found on sigmoidoscopy in asymptomatic people?.  J Clin Gastroenterol. 1992;  15 113-116
  • 6 Granqvist S, Gabrielsson N, Sundelin P. Diminutive colonic polyps – clinical significance and management.  Endoscopy. 1979;  11 36-42
  • 7 Tedesco F J, Hendrix J C, Pickens C A et al. Diminutive polyps: histopathology, spatial distribution, and clinical significance.  Gastrointest Endosc. 1982;  28 1-5
  • 8 Lieberman D, Moravec M, Holub J et al. Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography.  Gastroenterology. 2008;  135 1100-1105
  • 9 Farrar W D, Sawhney M S, Nelson D B et al. Colorectal cancers found after a complete colonoscopy.  Clin Gastroenterol Hepatol. 2006;  4 1259-1264
  • 10 Pabby A, Schoen R E, Weissfeld J L et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial.  Gastrointest Endosc. 2005;  61 385-391
  • 11 Leung K, Pinsky P, Laiyemo A O et al. Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study.  Gastrointest Endosc. 2010;  71 111-117
  • 12 Singh N, Harrison M, Rex D K. A survey of colonoscopic polypectomy practices among clinical gastroenterologists.  Gastrointest Endosc. 2004;  60 414-418
  • 13 Brenner H, Hoffmeister M, Arndt V et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study.  J Natl Cancer Inst. 2010;  102 89-95
  • 14 Baxter N N, Goldwasser M A, Paszat L F et al. Association of colonoscopy and death from colorectal cancer.  Ann Intern Med. 2009;  150 1-8
  • 15 Yoshida D, Kono S, Moore M A et al. Colorectal polypectomy and risk of colorectal cancer by subsite: the Fukuoka Colorectal Cancer study.  Jpn J Clin Oncol. 2007;  37 597-602
  • 16 Pohl H, Robertson D J. Colorectal cancers detected after colonoscopy frequently result from missed lesions.  Clin Gastroenterol Hepatol. 2010;  8 858-864
  • 17 Arain M A, Sawhney M, Sheikh S et al. CIMP status of interval colon cancers: another piece to the puzzle.  Am J Gastroenterol. 2010;  105 1189-1195
  • 18 Sawhney M S, Farrar W D, Gudiseva S et al. Microsatellite instability in interval colon cancers.  Gastroenterology. 2006;  131 1700-1705
  • 19 Gorski T F, Rosen L, Riether R et al. Colorectal cancer after surveillance colonoscopy: false-negative examination or fast growth?.  Dis Colon Rectum. 1999;  42 877-880
  • 20 Woods A, Sanowski R A, Wadas D D et al. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal.  Gastrointest Endosc. 1989;  35 536-540
  • 21 Wadas D D, Sanowski R A. Complications of the hot biopsy forceps technique.  Gastrointest Endosc. 1988;  34 32-37
  • 22 Nelson A M. Delayed hemorrhage following “hot biopsy” of a diminutive colonic polyp.  Gastrointest Endosc. 1990;  36 418
  • 23 Dyer W S, Quigley E M, Noel S M 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
  • 24 Humphris J, Tippett J, Kwok A, Katelaris P H. Cold snare polypectomy for diminutive polyps: an assessment of the risk of incomplete removal of small adenomas.  Gastrointest Endosc. 2009;  69 AB207
  • 25 Ellis K, Marquis S, Katon R. Efficacy of hot biopsy forceps, cold micro-snare and micro-snare with cautery techniques in the removal of diminutive colonic polyps.  Gastrointest Endosc. 1997;  45 AB107
  • 26 Borsato R, Kiafar C, Ramirez F. Cold Biopsy Polypectomy: Jumbo Versus Standard Size Biopsy Forceps.  Gastrointest Endosc. 2008;  67 AB288

R. Y. ChenMD 

St Vincent’s Hospital

Victoria Parade
Fitzroy 3065
Melbourne
Australia

Fax: +61-3-86781032

Email: robert.chen@svhm.org.au

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