Cold forceps polypectomy with NBI endoscopy noninferior to cold snare

WASHINGTON — Histologic polyp eradication rate using cold forceps polypectomy with narrow band imaging endoscopy showed noninferiority when compared with cold snare polypectomy for diminutive colonic polyps, according to data presented at Digestive Disease Week.

The thinking behind this study was that “complete resection rate would be increased with [cold forceps polypectomy] when detailed investigation of the remnant polyp by image-enhanced endoscopy is performed,” Soo-kyung Park, MD, from the Digestive Disease Center and Research Institute at SoonChunHyang University School of Medicine in Korea, said during her presentation. The aim of this study was to assess the adequacy of [diminutive colorectal polyp] resection using cold forceps polypectomy with NBI endoscopy [compared] with that of cold snare polypectomy.”

Park and colleagues performed a prospective, randomized, controlled, noninferiority trial from July to November, 2014, at a single tertiary referral hospital including adult patients (73.3% male; median age, 56 years) undergoing routine colonoscopy. Patients were randomly assigned to the cold forceps or cold snare group. Cold forceps were used to resect polyps until no polyp tissue was visible by NBI endoscopy, and histologic eradication was evaluated by at least two additional biopsies taken from the base and edges of the polypectomy site.

The cold forceps group included 76 patients with 116 polyps available for assessment, and the cold snare group included 70 patients with 115 polyps available for assessment. Overall, 55.8% of polyps were greater than 3 mm in size, 40.7% were located in the descending/sigmoid colon and 79.6% were adenomas.

“There was no significant difference in the polyp characteristics between the two groups,” Park said.

Histologic eradication rate was 90.5% in the cold forceps group and 93% in the cold snare group representing a difference of 2.5% (95% CI, –9.67 to 4.62) and showing noninferiority of cold forceps compared with the cold snare (non-inferiority margin –10 < –9.67). There was no difference in time taken for polypectomy or complications between groups, but failure of tissue retrieval was higher in the cold snare group (7.8 % vs. 0%, P = .001).

“Cold forceps polypectomy appears to be adequate for the resection of the majority of [diminutive colon polyps] if no residual tissue is visible by NBI endoscopy,” Park concluded. – by Adam Leitenberger

For more information:

Park S, et al. Abstract 712. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.

Disclosure: Park reports no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.