Akira Teramoto1, Nobuo Aoyama2, Chikara Ebisutani3, Tsuguhiro Matsumoto4, Hirohisa Machida5, Shiei Yoshida6, Nobufumi Uchima7, Takahiro Utsumi8, Tomomasa Tochio9, Daizen Hirata1, Mineo Iwatate1, Santa Hattori1, Mikio Fujita1, Wataru Sano1, Yasushi Sano1. 1. Gastrointestinal Center, Sano Hospital, Kobe, Japan. 2. Department of Gastroenterology, Aoyama Clinic, Kobe, Japan. 3. Department of Gastroenterology, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan. 4. Department of Gastroenterology, Akashi City Hospital, Akashi, Japan. 5. Department of Internal Medicine, Machida Gastrointestinal Hospital, Osaka, Japan. 6. Department of Gastroenterology, National Hospital Organization Kobe Medical Center, Kobe, Japan. 7. Gastrointestinal Center, Urasoe General Hospital, Urasoe, Japan. 8. Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 9. Gastrointestinal Center, Sano Hospital, Kobe, Japan; Department of Gastroenterology, Suzuka Central General Hospital, Suzuka, Japan.
Abstract
BACKGROUND AND AIMS: Colorectal polyps are often detected during the insertion phase of colonoscopy but are commonly removed during the withdrawal phase. We aimed to investigate the clinical advantages of instant removal of colorectal polyps during the insertion phase to determine the appropriate strategy for polyps detected on insertion. METHODS: This prospective, multicenter, randomized trial targeted patients with at least 1 left-sided polyp <10 mm in size detected unintentionally on endoscope insertion from April 2018 to March 2019. Patients were allocated to the following 2 groups: study group, consisting of patients who had polyp removal instantly on insertion, and control group, comprising patients who had the endoscope inserted to the cecum first and polyps removed subsequently on withdrawal. Carbon dioxide gas insufflation and cold polypectomy were applied to minimize the influences of polypectomy on endoscope insertion. Twenty advanced endoscopists from 7 community-based institutions participated in this trial. RESULTS: Of 1451 patients enrolled, 220 patients were eligible for full assessment. Mean total procedure time was significantly shorter in the study group (18.9 vs 22.3 minutes, P < .001). Mean pure cecal intubation time and number of polyps per patient were similar between the 2 groups. In the control group, among 107 polyps found during insertion, 48 (45.8%) required reinspection and 7 (6.5%) were completely missed, with an average reinspection time of approximately 3 minutes. CONCLUSIONS:Polypectomy during the insertion phase in the colon and rectum significantly shortens the total procedure time and eliminates all missed polyps without experiencing any disadvantages.
RCT Entities:
BACKGROUND AND AIMS: Colorectal polyps are often detected during the insertion phase of colonoscopy but are commonly removed during the withdrawal phase. We aimed to investigate the clinical advantages of instant removal of colorectal polyps during the insertion phase to determine the appropriate strategy for polyps detected on insertion. METHODS: This prospective, multicenter, randomized trial targeted patients with at least 1 left-sided polyp <10 mm in size detected unintentionally on endoscope insertion from April 2018 to March 2019. Patients were allocated to the following 2 groups: study group, consisting of patients who had polyp removal instantly on insertion, and control group, comprising patients who had the endoscope inserted to the cecum first and polyps removed subsequently on withdrawal. Carbon dioxide gas insufflation and cold polypectomy were applied to minimize the influences of polypectomy on endoscope insertion. Twenty advanced endoscopists from 7 community-based institutions participated in this trial. RESULTS: Of 1451 patients enrolled, 220 patients were eligible for full assessment. Mean total procedure time was significantly shorter in the study group (18.9 vs 22.3 minutes, P < .001). Mean pure cecal intubation time and number of polyps per patient were similar between the 2 groups. In the control group, among 107 polyps found during insertion, 48 (45.8%) required reinspection and 7 (6.5%) were completely missed, with an average reinspection time of approximately 3 minutes. CONCLUSIONS: Polypectomy during the insertion phase in the colon and rectum significantly shortens the total procedure time and eliminates all missed polyps without experiencing any disadvantages.