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Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection

  • Original Article—Alimentary Tract
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A Letter to the Editor to this article was published on 09 March 2019

Abstract

Background

Cold snare polypectomy (CSP) has not undergone sufficient histopathological evaluation. This study aimed to clarify the histopathological features of CSP specimens, including resection depth and layer, as compared with endoscopic mucosal resection (EMR).

Methods

Polyps were recruited retrospectively. Sessile, semi-pedunculated, and 0-IIa polyps of ≤ 9 mm were selected by propensity score matching and classified as either a complete resection or one with an unevaluable/positive (X/+) margin. Resection depth and layer were estimated and the risk factors for an X/+ margin were evaluated.

Results

A total of 1072 polyps were enrolled. After matching, 184 polyp pairs were selected. An X/+ margin was seen in 105/184 (57%) vs. 70/184 (38%) CSP vs. EMR specimens (p < 0.001): specimen damage was 53/184 (29%) vs. 30/184 (16%) (p < 0.01) and vertical margin (VM) X/+ was 11/184 (6%) vs. 2/184 (1%) (p < 0.05). Among 193 completely resected specimens, resection depth from the muscularis mucosae in CSP vs. EMR was 76 vs. 338 µm (p < 0.001) and resection layer was the submucosa in 7/79 (9%) vs. 105/114 (92%) (p < 0.001). In multivariate analysis, CSP was a risk factor for procedure-associated VMX/+ [odds ratio (OR) 6.80, 95% confidence interval (CI) 1.33–34.69, p < 0.05]. Sessile serrated adenoma/polyp (SSA/P) was a risk factor for VMX/+ margin in CSP specimens (OR 58.36, 95% CI 7.45–456.96, p < 0.001).

Conclusions

SSA/P and colorectal cancer may not be suitable for CSP adoption.

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Abbreviations

CSP:

Cold snare polypectomy

EMR:

Endoscopic mucosal resection

X/+:

Unevaluable/positive

VM:

Vertical margin

HM:

Horizontal margin

IQR:

Interquartile range

OR:

Odds ratio

CI:

Confidence interval

FOBT:

Fecal occult blood test

SSA/P:

Sessile serrated adenoma/polyp

CFP:

Cold forceps polypectomy

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Acknowledgements

The manuscript was edited for clarity, consistency, and English language usage by Aaron S Karat and Trevor Ralph.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan

    Akihiro Ito, Akihiro Matsumoto & Eiji Tanaka

  2. Endoscopic Examination Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Tomoaki Suga

  3. Department of Biomedical Sciences, School of Health Sciences, Shinshu University School of Medicine, Matsumoto, Japan

    Hiroyoshi Ota

  4. Tateiwa Clinic, Nagano, Japan

    Nobuyuki Tateiwa

Authors
  1. Akihiro Ito
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  2. Tomoaki Suga
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  3. Hiroyoshi Ota
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  4. Nobuyuki Tateiwa
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  5. Akihiro Matsumoto
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  6. Eiji Tanaka
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Correspondence to Tomoaki Suga.

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Ito, A., Suga, T., Ota, H. et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 53, 1171–1178 (2018). https://doi.org/10.1007/s00535-018-1446-2

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  • DOI: https://doi.org/10.1007/s00535-018-1446-2

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