Intest Res.  2019 Apr;17(2):265-272. 10.5217/ir.2018.00103.

Efficacy and safety of cold forceps polypectomy utilizing the jumbo cup: a prospective study

• Hasegawa H
• Bamba S
• Takahashi
• Murata M
• Otsuka T
• Matsumoto
• Fujimoto T
• Osak R
• Imaeda H
• Nishida A
• Ban H
• Sonoda A
• Inatomi O
• Sasaki M
• Sugimoto M
• Andoh A

• KMID: 2449968
• DOI: http://doi.org/10.5217/ir.2018.00103

Abstract

BACKGROUND/AIMS
There are few prospective studies on cold forceps polypectomy (CFP) using jumbo cup forceps. Therefore, we examined patients with diminutive polyps (5 mm or smaller) treated with CFP using jumbo cup forceps to achieve an adenoma-free colon and also assessed the safety of the procedure and the recurrence rate of missed or residual polyp after CFP by performing follow-up colonoscopy 1 year later.
METHODS
We included patients with up to 5 adenomas removed at initial colonoscopy and analyzed data from a total of 361 patients with 573 adenomas. One-year follow-up colonoscopy was performed in 165 patients, at which 251 lesions were confirmed.
RESULTS
The one-bite resection rate with CFP was highest for lesions 3 mm or smaller and decreased significantly with increasing lesion size. Post-procedural hemorrhage was observed in 1 of 573 lesions (0.17%). No perforation was noted. The definite recurrence rate was 0.8% (2/251 lesions). The probable recurrence rate, which was defined as recurrence in the same colorectal segment, was 17%. Adenoma-free colon was achieved in 55% of patients at initial resection. Multivariate analysis revealed that achievement of an adenoma-free colon was significantly associated with number of adenomas and years of endoscopic experience.
CONCLUSIONS
CFP using jumbo biopsy forceps was safe and showed a high one-bite resection rate for diminutive lesions of 3 mm or smaller. The low definite recurrence rate confirms the reliability of CFP using jumbo biopsy forceps. Number of adenomas and years of endoscopic experience were key factors in achieving an adenoma-free colon.

Keyword

Diminutive polyp; Adenoma; One-bite resection; Recurrence; Hemorrhage

MeSH Terms

Adenoma
Biopsy
Colon
Colonoscopy
Follow-Up Studies
Hemorrhage
Humans
Multivariate Analysis
Polyps
Prospective Studies*
Recurrence
Surgical Instruments*

Figure

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  Fig. 1. Flowchart of the study participants. SSA/P, sessile serrated adenoma/polyp; CFP, cold forceps polypectomy.

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  Fig. 2. One-bite resection rate and size of the adenoma. Chi-square test.

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  Fig. 3. Cases of definite recurrence. Recurrence of adenoma is noted in the same segment as the initial resection site. (A) Case 1: 72-year-old male, Isp polyp, 5 mm in diameter was resected with one-bite cold forceps polypectomy. The pathology was low-grade adenoma. The resection margin was diagnosed as negative. (B) Case 2: 70-year-old male, Is polyp, 3 mm in diameter was resected with one-bite cold forceps polypectomy. The pathology was low-grade adenoma. The resection margin was undetermined.

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  Fig. 4. Percentage of new lesions found at 1-year follow-up colonoscopy in the same segment as the original adenoma resection site at initial colonoscopy or in a different segment. Segments labeled in black represent the number of patients (with definite or probable recurrence) with a noted adenomatous lesion at the 1-year follow-up. Chi-square test.

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  Fig. 5. Percentage of missed polyps in each segment at 1-year follow-up colonoscopy. C, cecum; A, ascending colon; T, transverse colon; D, descending colon; S, sigmoid colon; R, rectum.

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