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Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps

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Abstract

Background

Local recurrence after cold snare polypectomy (CSP) of colorectal polyps has not been well analyzed. In this study, we analyzed the characteristics of local recurrence.

Methods

We retrospectively reviewed consecutive lesions resected by CSP from 2014 to 2016 and lesions that were followed up at ≥ 10 months after CSP, were analyzed. Our indication for CSP was a benign tumor of < 15 mm in size. We analyzed local recurrence and its risk factors using multivariate analyses. In addition, we compared lesions of ≥ 10 mm and < 10 mm. Moreover, therapeutic methods for recurrence were analyzed.

Results

Finally, we analyzed 554 cases out of 820 consecutive cases. The mean polyp size was 5.3 ± 2.8 mm and the en bloc resection and histopathological complete resection rates were 99.3% and 70.2%, respectively. The overall recurrence rate was 1.9% (mean follow-up period: 13.0 ± 4.0 months). Significant differences were observed between 11 recurrent lesions and 543 lesions without recurrence regarding polyp size (8.0 ± 3.7 mm vs. 5.2 ± 2.7 mm, p < 0.001), rate of sessile-serrated polyp (27.3% vs. 3.0%, p < 0.001), and histopathological positive margin (45.4% vs. 3.7%, p = 0.019). Multivariate analyses showed that a histopathological positive margin was the only significant risk factor for local recurrence (OR 16.600, 95% CI 3.707–74.331, p < 0.001). Regarding the comparison between 74 lesions of ≥ 10 mm and 480 lesions of < 10 mm, significant differences were observed in the en bloc resection rate (93.2% vs. 100%, p < 0.001), high-grade dysplasia rate (8.1% vs. 0.8%, p < 0.001), and histopathological complete resection rate (54.0% vs. 72.7%, p = 0.001). The recurrence rates of these two groups were 5.4% and 1.4%, respectively (p = 0.069). All recurrent cases could be resected with repeat CSP.

Conclusions

The local recurrence rate after CSP for lesions of < 10 mm was 1.4%. CSP was not recommended for lesions of ≥ 10 mm due to high rates of recurrence and malignancy.

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Acknowledgements

We thank all the members of the Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine for their help with the present study.

Funding

There was no funding in this paper.

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Authors and Affiliations

  1. Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan

    Takaaki Murakami, Hideyuki Konishi, Yuji Naito & Yoshito Itoh

  2. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Ritsu Yasuda, Ryohei Hirose, Ken Inoue, Osamu Dohi, Kazuhiro Kamada & Kazuhiko Uchiyama

  3. Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yukiko Morinaga, Mitsuo Kishimoto & Eiichi Konishi

  4. Department of Molecular Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Kiyoshi Ogiso

  5. Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan

    Yutaka Inada

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  1. Takaaki Murakami
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Corresponding author

Correspondence to Naohisa Yoshida.

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Disclosures

Dr. Yuji Naito and Dr. Naohisa Yoshida received a research grant from Fujifilm Co. Dr. Takaaki Murakami, Dr. Ritsu Yasuda, Dr. Ryohei Hirose, Dr. Ken Inoue, Dr. Osamu Dohi, Dr. Kazuhiro Kamada, Dr. Kazuhiko Uchiyama, Dr. Hideyuki Konishi, Dr. Yukiko Morinaga, Dr. Mitsuo Kishimoto, Dr. Eiichi Konishi, Dr. Kiyoshi Ogiso, Dr. Yutaka Inada, Dr. Yoshito Itoh have no conflicts of interest to declare.

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Murakami, T., Yoshida, N., Yasuda, R. et al. Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps. Surg Endosc 34, 2918–2925 (2020). https://doi.org/10.1007/s00464-019-07072-7

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