Diminutif Poliplerin Endoskopik Tedavisinde Jumbo Forseps ve Soğuk Snare ile Polipektomi Yöntemlerinin Karşılaştırılması

Öz

Amaç: Kolonoskopi sırasında bulunan poliplerin çoğu 5 mm’nin altındadır. Polipektomi teknikleri endoskopistler arasında çok değişkendir ve endoskopistin tercihine göre belirlenmektedir. Bu çalışmada diminutif polip (DP) olarak adlandırılan, ≤5 mm poliplerde, jumbo forseps (JFP) ve soğuk snare (CSP) ile yapılan polipektomilerin tam rezeksiyon oranları ve komplikasyonlar yönünden karşılaştırılması amaçlanmıştır.
Materyal ve Metot: Kliniğimizde herhangi bir nedenle kolonoskopi yapılan ve ≤5 mm polip saptanan hastalar; JFP ve CSP grubu olarak iki gruba randomize edildi. Polipektomi yöntemleri komplikasyon ve rezeksiyon açısından karşılaştırıldı.
Bulgular: Toplam 100 polipektomi işlemi (JFP grubu=50 ve CSP grubu=50) analiz edildi. Ortalama hasta yaşı 59,1±11,2 yıldı ve 54'ü (%54) erkekti. Hastaların demografik özellikleri ve polip karakteristikleri gruplar arasında benzerdi. DP'ler için genel tam rezeksiyon oranı, JFP ve CSP grupları arasında önemli ölçüde farklı değildi (%90'a karşı %82, P=0,38). ≤3 mm poliplerde polipektomi süresi CSP grubunda anlamlı olarak uzundu (p=0,008). CSP grubunda %4 minör kanama izlendi ve 4 polip (%8) çıkartılamadı. Komplikasyon oranı CSP grubunda anlamlı olarak yüksek saptandı (p=0,01).
Sonuç: ≤5 mm kolorektal poliplerin eksizyonunda, rezidü açısından JFP ve CSP yöntemlerinin birbirlerine üstünlük sağladıkları gösterilmemiştir, ancak JFP yöntemi ile komplikasyon oranları daha düşük saptanmıştır. 

Anahtar Kelimeler

• endoskopik polipektomi
• jumbo forseps
• soğuk snare
• diminutif polip

Jumbo Forceps Polypectomy Versus Cold Snare Polypectomy for Removal of Diminutif Colorectal Polyps

Abstract

Objective: Most polyps found during colonoscopy are diminutive (≤5 mm). Polypectomy techniques are highly variable and determined by the endoscopist's preference. The aim of this study was to compare the efficacy and safety of jumbo forceps polypectomy (JFP) and cold snare polypectomy (CSP) for the removal of diminutive polyps (DP).
Materials and Methods: Patients who underwent colonoscopy for any reason in our clinic and were found to have DP were randomized into two groups as JFP and CSP. The main outcome was complete polyp resection and complication rate.
Results: A total of 100 polypectomies (50 in each group) were analyzed. The mean age of the patients was 59.1±11.2 years. Demographic characteristics of the patients were similar between groups. The overall rate of complete resection for DPs was not significantly different between JFP and CSP groups (90% versus 82%, p=0.38). Polypectomy time was significantly longer in the CSP group for polyps ≤3 mm (p=0.008). 4% minor bleeding and 8% tissue retrieval failure were noted for polyps resected by CSP. The complication rate was significantly higher in the CSP group (p=0.01).
Conclusion: JBF and CSP are not statistically different in completely removing DPs. However, the complication rate was lower in the JFP group. 

Keywords

• endoscopic polypectomy
• jumbo forceps
• cold snare
• diminutif polyps

Kaynakça

1. Zauber AG, Winawer SJ, O'Brien MJ, ve ark. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687-696. doi:10.1056/NEJMoa1100370
2. Huh CW, Kim JS, Choi HH, Maeng IS, Jun SY, Kim BW. Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: a prospective randomized controlled trial. Gastrointest Endosc. 2019;90(1):105-111. doi:10.1016/j.gie.2019.01.016
3. Anderloni A, Jovani M, Hassan C, Repici A. Advances, problems, and complications of polypectomy. Clin Exp Gastroenterol. 2014;7:285-296. doi:10.2147/CEG.S43084
4. Pedersen IB, Loberg M, Hoff G, Kalager M, Bretthauer M, Holme O. Polypectomy techniques among gastroenterologists in Norway - a nationwide survey. Endosc Int Open. 2018;6(7):E812-E820. doi:10.1055/a-0607-0727
5. Liu S, Ho SB, Krinsky ML. Quality of polyp resection during colonoscopy: are we achieving polyp clearance? Dig Dis Sci. 2012;57(7):1786-1791. doi:10.1007/s10620-012-2115-6
6. Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43(4):312-316. doi:10.1055/s-0030-1256086
7. Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. Cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol. 2013;108(10):1593-1600. doi:10.1038/ajg.2013.302
8. Draganov PV, Chang MN, Alkhasawneh A, ve ark. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012;75(1):118-126. doi:10.1016/j.gie.2011.08.019

9. Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci. 2011;56(8):2384-2388. doi:10.1007/s10620-011-1598-x
10. Pohl H, Srivastava A, Bensen SP, ve ark. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology. 2013;144(1):74-80.e1. doi:10.1053/j.gastro.2012.09.043
11. Mönkemüller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004;36(5):432-436. doi:10.1055/s-2004-814321
12. Kim JS, Lee BI, Choi H, ve ark. Cold snare polypectomy versus cold forceps polypectomy for diminutive and small colorectal polyps: a randomized controlled trial. Gastrointest Endosc. 2015;81(3):741-747. doi:10.1016/j.gie.2014.11.048
13. Park SK, Ko BM, Han JP, Hong SJ, Lee MS. A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps. Gastrointest Endosc. 2016;83(3):527-532. doi:10.1016/j.gie.2015.08.053
14. Raad D, Tripathi P, Cooper G, Falck-Ytter Y. Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. Gastrointest Endosc. 2016;83(3):508-515. doi:10.1016/j.gie.2015.10.038
15. Deenadayalu VP, Rex DK. Colon polyp retrieval after cold snaring. Gastrointest Endosc. 2005;62(2):253-256. doi: 10.1016/s0016-5107(05)00376-7
16. Komeda Y, Suzuki N, Sarah M, ve ark. Factors associated with failed polyp retrieval at screening colonoscopy. Gastrointest Endosc. 2013;77(3):395-400. doi:10.1016/j.gie.2012.10.007
17. Fyock CJ, Draganov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2010;16(29):3630-3637. doi:10.3748/wjg.v16.i29.3630
18. Jung YS, Park CH, Nam E, Eun CS, Park DI, Han DS. Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis. Surg Endosc. 2018;32(3):1149-1159. doi:10.1007/s00464-017-5786-4
19. Ichise Y, Horiuchi A, Nakayama Y, Tanaka N. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84(1):78-81. doi:10.1159/000323959