Polypectomy during colonoscopy insertion reduces procedure time, missed polyps
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Removing polyps that are unintentionally located during the colonoscopy insertion phase rather than waiting until withdrawal helped reduce the number of missed polyps and shortened the total procedure time, according to study results.
Akira Teramoto, MD, of the Sano Hospital gastrointestinal center in Japan, and colleagues wrote that there are currently no clear recommendations for the management of polyps that are found during insertion.
“As a result, polyps detected upon insertion are commonly removed upon endoscope withdrawal after reaching the cecum,” they wrote. “However, these polyps, especially those in the left side of the colon, are not easily found during the withdrawal phase, unless they were removed instantly upon insertion.”
Researchers conducted a multicenter, randomized trial comprising 220 patients who had at least one left-sided polyp less than 10 mm in size that was located unintentionally upon endoscope insertion. They separated patients into two groups. In the first, they removed the polyps immediately during insertion, and in the second (control group), they completed insertion to the cecum first before returning to the polyps during withdrawal.
Both study groups had similar mean pure cecal intubation times and number of polyps per patient. However, the mean total procedure time was shorter in the group in which polyps were removed during insertion (18.9 vs. 22.3 minutes; P < .001).
In the control group, endoscopists found 107 polyps during insertion. During withdrawal, they were only able the find 41 (44.8%) during the first attempt and seven polyps were lost completely (6.5%). The mean reinspection time for hiding and missed polyps were 2.5 and 4.7 minutes, respectively.
“Our data showed that cold polypectomy during the insertion phase significantly improves time efficiency of colonoscopy and eliminates all missed polyps without experiencing any disadvantages,” Teramoto and colleagues concluded. “Consequently, the standard approach of polypectomy in the daily practice may be altered in the future.” – by Alex Young
Disclosure: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.
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