Said Din1,2, Alex J Ball3,4, Eleanor Taylor3, Matthew Rutter5,6, Stuart A Riley3, Shawinder Johal3. 1. Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK. said.din1@nhs.net. 2. Department of Oncology, University of Sheffield Medical School, Sheffield, UK. said.din1@nhs.net. 3. Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK. 4. Department of Oncology, University of Sheffield Medical School, Sheffield, UK. 5. North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK. 6. Durham University Medicine, Durham, UK.
Abstract
BACKGROUND: Most colonic polyps are small, and several polypectomy techniques are available. We aimed to describe the variation in polypectomy techniques employed for the removal of sub-centimeter polyps in relation to polyp characteristics, completeness of histological excision and safety. METHODS: Prospectively collected data relating to the removal of sub-centimeter polyps over a 3-year period (between January 2010 and December 2012) were retrieved from the English Bowel Cancer Screening Programme. RESULTS: A total of 147,174 sub-centimeter polyps were removed during 62,679 procedures. For pedunculated polyps, hot snare was most common in the left (median 92 %, IQR 83.3-97.0 %) and right colon (median 75 %, IQR 3-92 %). For non-pedunculated polyps, cold snare was most common in the right colon (median 24 %, IQR 9-47 %); whereas hot snare remained most common in the left colon (median 32 %, IQR 19-49 %). Surgeons were more likely than physicians to use diathermy-assisted techniques (65.6 vs. 56.5 %, p < 0.001). Twelve (0.03 %) bleeding episodes required transfusion with no polypectomy technique dominating and 16 (0.04 %) perforations with 81 % of polypectomies performed using diathermy-assisted techniques. There was substantial variation between screening centers for the completeness of histological excision. For non-pedunculated polyps, histologically confirmed complete excision was more after EMR (23.4 %) compared with other techniques (cold biopsy forceps 17.7 %, cold snare 15.1 %, hot biopsy forceps 19.1 %, hot snare 21.5 %). The use of cold techniques and EMR has increased over time, whereas the use of hot biopsy forceps and hot snare has decreased (p < 0.001). CONCLUSIONS: The removal of sub-centimeter polyps within the BCSP is safe despite wide variations in practice. The use of cold resection techniques and EMR has increased over time. The histological assessment for completeness of excision is limited and should be confirmed endoscopically at the time of polypectomy.
BACKGROUND: Most colonic polyps are small, and several polypectomy techniques are available. We aimed to describe the variation in polypectomy techniques employed for the removal of sub-centimeter polyps in relation to polyp characteristics, completeness of histological excision and safety. METHODS: Prospectively collected data relating to the removal of sub-centimeter polyps over a 3-year period (between January 2010 and December 2012) were retrieved from the English Bowel Cancer Screening Programme. RESULTS: A total of 147,174 sub-centimeter polyps were removed during 62,679 procedures. For pedunculated polyps, hot snare was most common in the left (median 92 %, IQR 83.3-97.0 %) and right colon (median 75 %, IQR 3-92 %). For non-pedunculated polyps, cold snare was most common in the right colon (median 24 %, IQR 9-47 %); whereas hot snare remained most common in the left colon (median 32 %, IQR 19-49 %). Surgeons were more likely than physicians to use diathermy-assisted techniques (65.6 vs. 56.5 %, p < 0.001). Twelve (0.03 %) bleeding episodes required transfusion with no polypectomy technique dominating and 16 (0.04 %) perforations with 81 % of polypectomies performed using diathermy-assisted techniques. There was substantial variation between screening centers for the completeness of histological excision. For non-pedunculated polyps, histologically confirmed complete excision was more after EMR (23.4 %) compared with other techniques (cold biopsy forceps 17.7 %, cold snare 15.1 %, hot biopsy forceps 19.1 %, hot snare 21.5 %). The use of cold techniques and EMR has increased over time, whereas the use of hot biopsy forceps and hot snare has decreased (p < 0.001). CONCLUSIONS: The removal of sub-centimeter polyps within the BCSP is safe despite wide variations in practice. The use of cold resection techniques and EMR has increased over time. The histological assessment for completeness of excision is limited and should be confirmed endoscopically at the time of polypectomy.
Authors: Klaus Mönkemüller; Helmut Neumann; Peter Malfertheiner; Lucia C Fry Journal: Clin Gastroenterol Hepatol Date: 2009-03-10 Impact factor: 11.382
Authors: Thomas J W Lee; Matthew D Rutter; Roger G Blanks; Sue M Moss; Andrew F Goddard; Andrew Chilton; Claire Nickerson; Richard J Q McNally; Julietta Patnick; Colin J Rees Journal: Gut Date: 2011-09-22 Impact factor: 23.059
Authors: Peter V Draganov; Myron N Chang; Ahmad Alkhasawneh; Lisa R Dixon; John Lieb; Baharak Moshiree; Steven Polyak; Shahnaz Sultan; Dennis Collins; Amitabh Suman; John F Valentine; Mihir S Wagh; Samir L Habashi; Chris E Forsmark Journal: Gastrointest Endosc Date: 2012-01 Impact factor: 9.427
Authors: Nancy N Baxter; Meredith A Goldwasser; Lawrence F Paszat; Refik Saskin; David R Urbach; Linda Rabeneck Journal: Ann Intern Med Date: 2008-12-15 Impact factor: 25.391
Authors: D A Gilbert; A J DiMarino; D M Jensen; R Katon; M B Kimmey; L A Laine; B V MacFadyen; P A Michaletz-Onody; G Zuckerman Journal: Gastrointest Endosc Date: 1992 Nov-Dec Impact factor: 9.427
Authors: Michal F Kaminski; Siwan Thomas-Gibson; Marek Bugajski; Michael Bretthauer; Colin J Rees; Evelien Dekker; Geir Hoff; Rodrigo Jover; Stepan Suchanek; Monika Ferlitsch; John Anderson; Thomas Roesch; Rolf Hultcranz; Istvan Racz; Ernst J Kuipers; Kjetil Garborg; James E East; Maciej Rupinski; Birgitte Seip; Cathy Bennett; Carlo Senore; Silvia Minozzi; Raf Bisschops; Dirk Domagk; Roland Valori; Cristiano Spada; Cesare Hassan; Mario Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2017-03-16 Impact factor: 4.623
Authors: Jeremy P Dwyer; Jonathan Y C Tan; Paul Urquhart; Robyn Secomb; Catherine Bunn; John Reynolds; Richard La Nauze; William Kemp; Stuart Roberts; Gregor Brown Journal: Endosc Int Open Date: 2017-10-27