A W Yen1,2, A Amato3, S Cadoni4, S Friedland5,6, Y H Hsieh7,8, J W Leung9,10, M Liggi4, J Sul11,12, F W Leung12,13. 1. Division of Gastroenterology, Sacramento VA Medical Center, VANCHCS, 10535 Hospital Way, 111/G, Mather, CA, 95655, USA. andrew.yen3@va.gov. 2. University of California Davis School of Medicine, Sacramento, CA, USA. andrew.yen3@va.gov. 3. Division of Gastroenterology, Valduce Hospital, Como, Italy. 4. Digestive Endoscopy Unit, S. Barbara Hospital, 09016, Iglesias, CI, Italy. 5. Division of Gastroenterology, Palo Alto VAMC, Palo Alto, CA, USA. 6. Stanford University, Palo Alto, CA, USA. 7. Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China. 8. Tzu Chi University, Hualien, Taiwan, Republic of China. 9. Division of Gastroenterology, Sacramento VA Medical Center, VANCHCS, 10535 Hospital Way, 111/G, Mather, CA, 95655, USA. 10. University of California Davis School of Medicine, Sacramento, CA, USA. 11. Division of Gastroenterology, West Los Angeles VAMC, VAGLAHS, Los Angeles, CA, USA. 12. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. 13. Division of Gastroenterology, VAGLAHS, Sepulveda ACC, North Hill, CA, USA.
Abstract
BACKGROUND: Underwater polypectomy (UWP) of large (≥ 20 mm) colorectal lesions is well described, but reports of UWP for lesions ≤ 20 mm in size, which account for > 95% of polyps encountered in routine clinical practice, are limited. We assessed the feasibility of UWP in routine practice across various sites for colorectal lesions ≤ 20 mm in size. METHODS: A multicenter retrospective study was performed on pooled data from nine colonoscopists at 3 U.S., 1 Taiwanese and 2 Italian sites. Outcomes related to UWP on lesions ≤ 20 mm in size were analyzed. RESULTS: In 117 patients, UWP netted 169 lesions. Polypectomy by hot (HSP, 54%) or cold (CSP, 41%) snare, and cold forceps (CFP, 5%) were performed successfully without endoscopic evidence of residual neoplasia or immediate clinically significant adverse events. The majority (74.6%) were tubular adenomas; 60.9% were from the proximal colon. Histopathologic margins were positive in 4 and unavailable in 26 CSP and 24 HSP specimens. The remainder had negative resection margins on pathologic reports. CONCLUSION: UWP for colorectal lesions ≤ 20 mm in routine practice across multiple sites confirms the feasibility and acceptability of this technique. Improvement of resection outcomes by UWP in routine practice deserves further evaluation in a randomized controlled trial.
BACKGROUND: Underwater polypectomy (UWP) of large (≥ 20 mm) colorectal lesions is well described, but reports of UWP for lesions ≤ 20 mm in size, which account for > 95% of polyps encountered in routine clinical practice, are limited. We assessed the feasibility of UWP in routine practice across various sites for colorectal lesions ≤ 20 mm in size. METHODS: A multicenter retrospective study was performed on pooled data from nine colonoscopists at 3 U.S., 1 Taiwanese and 2 Italian sites. Outcomes related to UWP on lesions ≤ 20 mm in size were analyzed. RESULTS: In 117 patients, UWP netted 169 lesions. Polypectomy by hot (HSP, 54%) or cold (CSP, 41%) snare, and cold forceps (CFP, 5%) were performed successfully without endoscopic evidence of residual neoplasia or immediate clinically significant adverse events. The majority (74.6%) were tubular adenomas; 60.9% were from the proximal colon. Histopathologic margins were positive in 4 and unavailable in 26 CSP and 24 HSP specimens. The remainder had negative resection margins on pathologic reports. CONCLUSION: UWP for colorectal lesions ≤ 20 mm in routine practice across multiple sites confirms the feasibility and acceptability of this technique. Improvement of resection outcomes by UWP in routine practice deserves further evaluation in a randomized controlled trial.
Entities:
Keywords:
Polypectomy; Underwater; Water exchange colonoscopy
Authors: Robert J Schenck; Darius A Jahann; James T Patrie; Edward B Stelow; Dawn G Cox; Dushant S Uppal; Bryan G Sauer; Vanessa M Shami; Daniel S Strand; Andrew Y Wang Journal: Surg Endosc Date: 2017-03-24 Impact factor: 4.584
Authors: S M Wildi; A M Schoepfer; S R Vavricka; H Fruehauf; E Safroneeva; N Wiegand; P Bauerfeind; M Fried Journal: Endoscopy Date: 2012-08-28 Impact factor: 10.093