Skip to main content
SpringerLink
Log in

Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The recurrence rate after standard cold forceps polypectomy (CFP) of diminutive polyps of ≤5 mm has not been fully determined. The aim of this study was to analyze the long-term follow-up results and recurrence rate after CFP of diminutive polyps.

Methods

We retrospectively reviewed the medical records of 884 (738 men; age 53 years) asymptomatic subjects who underwent surveillance colonoscopy after CFP of 1–2 diminutive adenomatous polyps. Cumulative recurrence at the CFP site and risk factors for recurrence were analyzed.

Results

Overall recurrence over 59.7 months was 17 % after CFP of 1111 diminutive polyps. The rate of definite recurrence was 4 %, and probable recurrence was 13 %. Recurrence as advanced adenoma was 0.5 % (5/1111). The cumulative probabilities of recurrence at 3, 5, and 7 years after CFP were 10.0, 16.0, and 21.1 %, respectively. Multivariate analysis revealed that polyp 4–5 mm in size and right colonic polyp were risk factors for recurrence (hazard ratio [HR] 1.37; 95 % confidence interval [CI] 1.01–1.86 and HR 1.49; 95 % CI 1.08–2.04, respectively). The recurrence rate for 10 endoscopists who performed at least 50 CFPs ranged from 11.0 to 25.2 %; the probability of recurrence in those in the top half in terms of recurrence rate was 1.6-fold higher than that of those in the bottom half (95 % CI 1.17–2.19).

Conclusions

Although recurrence may develop after standard CFP of diminutive polyps, recurrence as advanced adenoma is rare. Large polyp size, right colon polyp, and endoscopist are risk factors for recurrence after standard CFP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hassan C, Pickhardt PJ, Kim DH, Di Giulio E, Zullo A, Laghi A, Repici A, Iafrate F, Osborn J, Annibale B (2010) Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy. Aliment Pharmacol Ther 31:210–217

    CAS  PubMed  Google Scholar 

  2. Lieberman D, Moravec M, Holub J, Michaels L, Eisen G (2008) Polyp size and advanced histology in patients undergoing colonoscopy screening: implications for CT colonography. Gastroenterology 135:1100–1105

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR, United States multi-society task force on Colorectal C (2012) Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US multi-society task force on colorectal cancer. Gastroenterology 143:844–857

    Article  PubMed  Google Scholar 

  4. Gupta N, Bansal A, Rao D, Early DS, Jonnalagadda S, Wani SB, Edmundowicz SA, Sharma P, Rastogi A (2012) Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc 75:1022–1030

    Article  PubMed  Google Scholar 

  5. Ignjatovic A, East JE, Suzuki N, Vance M, Guenther T, Saunders BP (2009) Optical diagnosis of small colorectal polyps at routine colonoscopy (Detect InSpect ChAracterise Resect and Discard; DISCARD trial): a prospective cohort study. Lancet Oncol 10:1171–1178

    Article  PubMed  Google Scholar 

  6. Rex DK (2009) Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps. Gastroenterology 136:1174–1181

    Article  PubMed  Google Scholar 

  7. Rex DK, Kahi C, O’Brien M, Levin TR, Pohl H, Rastogi A, Burgart L, Imperiale T, Ladabaum U, Cohen J, Lieberman DA (2011) The american society for gastrointestinal endoscopy PIVI (Preservation and Incorporation of Valuable Endoscopic Innovations) on real-time endoscopic assessment of the histology of diminutive colorectal polyps. Gastrointest Endosc 73:419–422

    Article  PubMed  Google Scholar 

  8. Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY (2011) Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy 43:312–316

    Article  CAS  PubMed  Google Scholar 

  9. Liu S, Ho SB, Krinsky ML (2012) Quality of polyp resection during colonoscopy: are we achieving polyp clearance? Dig Dis Sci 57:1786–1791

    Article  PubMed  Google Scholar 

  10. Jung YS, Park JH, Kim HJ, Cho YK, Sohn CI, Jeon WK, Kim BI, Sohn JH, Park DI (2013) Complete biopsy resection of diminutive polyps. Endoscopy 45:1024–1029

    Article  PubMed  Google Scholar 

  11. Lee CK, Shim JJ, Jang JY (2013) Cold snare polypectomy versus Cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol 108:1593–1600

    Article  PubMed  Google Scholar 

  12. Hamilton SR, Aaltonen LA (2000) Pathology and genetics of tumours of the digestive system. IARC press, Lyon

    Google Scholar 

  13. Participants in the Paris workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 58:S3–S43

    Article  Google Scholar 

  14. Singh N, Harrison M, Rex DK (2004) A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc 60:414–418

    Article  PubMed  Google Scholar 

  15. Matsuda T, Kawano H, Hisabe T, Ikematsu H, Kobayashi N, Mizuno K, Oka S, Takeuchi Y, Tamai N, Uraoka T, Hewett D, Chiu HM (2014) Current status and future perspectives of endoscopic diagnosis and treatment of diminutive colorectal polyps. Dig Endosc 26(Suppl 2):104–108

    Article  PubMed  Google Scholar 

  16. Cairns SR, Scholefield JH, Steele RJ, Dunlop MG, Thomas HJ, Evans GD, Eaden JA, Rutter MD, Atkin WP, Saunders BP, Lucassen A, Jenkins P, Fairclough PD, Woodhouse CR, British Society of G, Association of Coloproctology for Great B, Ireland (2010) Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 59:666–689

    Article  PubMed  Google Scholar 

  17. Samadder NJ, Curtin K, Tuohy TM, Pappas L, Boucher K, Provenzale D, Rowe KG, Mineau GP, Smith K, Pimentel R, Kirchhoff AC, Burt RW (2014) Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology 146:950–960

    Article  PubMed  Google Scholar 

  18. Farrar WD, Sawhney MS, Nelson DB, Lederle FA, Bond JH (2006) Colorectal cancers found after a complete colonoscopy. Clin Gastroenterol Hepatol 4:1259–1264

    Article  PubMed  Google Scholar 

  19. Robertson DJ, Lieberman DA, Winawer SJ, Ahnen DJ, Baron JA, Schatzkin A, Cross AJ, Zauber AG, Church TR, Lance P, Greenberg ER, Martinez ME (2014) Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 63:949–956

    Article  PubMed  Google Scholar 

  20. Aslan F, Cekic C, Camci M, Alper E, Ekinci N, Akpinar Z, Alpek S, Arabul M, Unsal B (2015) What is the most accurate method for the treatment of diminutive colonic polyps?: standard versus jumbo forceps polypectomy. Medicine (Baltimore) 94:e621

    Article  Google Scholar 

  21. Raad D, Tripathi P, Cooper G, Falck-Ytter Y (2016) Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. Gastrointest Endosc 83:508–515

    Article  PubMed  Google Scholar 

  22. Draganov PV, Chang MN, Alkhasawneh A, Dixon LR, Lieb J, Moshiree B, Polyak S, Sultan S, Collins D, Suman A, Valentine JF, Wagh MS, Habashi SL, Forsmark CE (2012) Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc 75:118–126

    Article  PubMed  Google Scholar 

  23. Pohl H, Srivastava A, Bensen SP, Anderson P, Rothstein RI, Gordon SR, Levy LC, Toor A, Mackenzie TA, Rosch T, Robertson DJ (2013) Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 144:74–80

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Korea

      Ho-Su Lee, Jae Seung Soh, Seohyun Lee, Jung Ho Bae, Dong-Hoon Yang, Seung-Jae Myung, Suk-Kyun Yang & Jeong-Sik Byeon

    2. Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, Korea

      Ho-Su Lee, Hye Won Park, Jong-Soo Lee, Jong Cheol Kim, Jaewon Choe, Hyo Jeong Lee & Hye-Sook Chang

    Authors
    1. Ho-Su Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Hye Won Park
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jong-Soo Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jong Cheol Kim
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Jaewon Choe
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Jae Seung Soh
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Seohyun Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Jung Ho Bae
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Hyo Jeong Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Dong-Hoon Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Seung-Jae Myung
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Suk-Kyun Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Hye-Sook Chang
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Jeong-Sik Byeon
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Hye-Sook Chang or Jeong-Sik Byeon.

    Ethics declarations

    Disclosures

    Ho-Su Lee, Hye Won Park, Jong-Soo Lee, Jong Cheol Kim, Jaewon Choe, Jae Seung Soh, Seohyun Lee, Jung Ho Bae, Hyo Jeong Lee, Dong-Hoon Yang, Seung-Jae Myung, Suk-Kyun Yang, Hye-Sook Chang, and Jeong-Sik Byeon have no conflict of interest or financial ties to disclose.

    Additional information

    Hye-Sook Chang and Jeong-Sik Byeon contributed equally to this study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Lee, HS., Park, H.W., Lee, JS. et al. Treatment outcomes and recurrence following standard cold forceps polypectomy for diminutive polyps. Surg Endosc 31, 159–169 (2017). https://doi.org/10.1007/s00464-016-4947-1

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-016-4947-1

    Keywords

    Search

    Navigation