EMR superiore a cold snare per i piccoli polipi

Polypectomy for the complete endoscopic resection of small colorectal polyps.Zhang Q, Gao P, Han B, Xu J, Shen Y. Gastrointest Endosc. 2017 Jun 21. [Epub ahead of print]

BACKGROUND AND AIMS:Small colorectal polyps are frequently encountered and may be incompletely removed during colonoscopy. The optimal technique for removal of small colorectal polyps is uncertain.

The aim of this study was to compare the incomplete resection rate (IRR) using endoscopic mucosal resection (EMR) or cold snare polypectomy (CSP) for the removal of small adenomatous polyps.METHODS:This was a prospective randomized controlled study from a tertiary referral center. A total of 358 patients who satisfied the inclusion criteria (polyp sized 6-9 mm) were randomized to the EMR (n =179) and CSP (n =179) groups and their polyps were treated with conventional EMR or CSP respectively. After polypectomy, an additional 5 forceps biopsies were performed at the base and margins of polypectomy site to assess the presence of residual polyp tissue. The EMR and CSP samples were compared to assess IRR.RESULTS:Among a total of 525 polyps, 415 (79.0%) were adenomatous polyps and 41(16.4%) were advanced adenoma. The overall IRR for adenomatous polyps was significantly higher in the CSP group compared with the EMR group (18/212, 8.5% vs 3/203, 1.5%; P = 0.001). Logistic regression analysis revealed that the CSP procedure was a stronger risk factor for IRR (OR, 6.924; 95% CI, 2.098-24.393; P = 0.003). In addition, piecemeal resection was the most important risk factor for IRR either (OR, 28.696; 95% CI, 3.620-227.497; P = 0.001). The mean procedure time for polypectomy was not significantly different between the EMR and the CSP groups (5.5 ± 2.7 vs 4.7 ± 3.4 minutes; P = 0.410). None of these patients presented with delayed bleeding. There were no severe adverse events related to the biopsies.CONCLUSIONS:EMR was significantly superior to CSP for achieving the complete endoscopic resection of small colorectal polyps. Patients with piecemeal resection of polyps had a higher risk for incomplete resection.

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