Hirofumi Fukushima, MD, PhD1, Naoto Sakamoto, MD, PhD1, Takashi Murakami, MD, PhD2, Hiroya Ueyama, MD, PhD2, Kenshi Matsumoto, MD, PhD2, Tomoyoshi Shibuya, PhD1, Akihito Nagahara, MD, PhD2
1Juntendo University School of Medicine, Tokyo, Tokyo, Japan; 2Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
Introduction: Screening colonoscopy with polypectomy of small polyp substantially reduces colorectal cancer incidence and mortality. CSP and HSP are two major methods for polypectomy. The basic difference of CSP and HSP is the use of a high frequency generator of HSP. HSP may damage deeper vessels with increased risk of delayed healing, thereby post-polypectomy bleeding and even perforation. For this reason, CSP is usually considered safer, in recent years, CSP has increasingly been used for the removal of colorectal polyps. On the other hand, CSP is concerned associate with a rate of incomplete resection. So far few studies have confirmed endoscopically the early condition after treatment . In this study, through a randomized controlled study, we evaluated to compare mucosal defects and healing one week after treatment, from polypectomy using CSP vs. HSP.
Methods: The 52 patients has tumor size under 10 mm were randomly divided into two groups using opaque envelopes: CP (n = 27) and HP (n = 25). We compared the mean tumor size, ulcer diameter one week after endoscopic treatment, exposed blood vessels, residual recurrence and contingencies for CSP and HSP. Pathological diagnosis of complete resection was defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps.
Results: The overall the mean tumor size did not differ between the two groups (CSP vs. HSP: 5.44 mm vs. 5.32 mm ). Ulcer base diameter one week after treatment is CSP group had a smaller compared to the HSP group (2.7mm vs. 4.84 mm ; p < 0.001). And the CSP group had a lower exposed blood vessels compared to the HSP group (7.4% vs. 36.0%; p < 0.05). Delayed perforation or bleeding was not recognized in any patient during the one weeks after treatment. One case of residual recurrence was admitted to CSP group.
Discussion: Our study findings show that although there is no difference tumor diameter between the two techniques, the size of ulcer diameter one weeks after treatment, resection time and the rate of post-polypectomy bleeding is lower with CSP. However remnant recurrence was observed only in CSP. In clinically, CSP can be safely used as one of the effectively techniques for the resection colorectal polyps, but It is important to make an accurate endoscopic diagnosis and exclude cancer before treatment.
Citation: Hirofumi Fukushima, MD, PhD; Naoto Sakamoto, MD, PhD; Takashi Murakami, MD, PhD; Hiroya Ueyama, MD, PhD; Kenshi Matsumoto, MD, PhD; Tomoyoshi Shibuya, PhD; Akihito Nagahara, MD, PhD. P1032 - A COMPARISON OF THE MUCOSAL DEFECTS AND HEALING BY HOT SNARE POLYPECTOMY (HSP) VS. COLD SNARE POLYPECTOMY (CSP) FOR ENDOSCOPIC REMOVAL OF COLORECTAL POLYPS. Program No. P1032. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.