Cold forceps polypectomy faster, no less effective vs. cold snare for ‘diminutive polyps’
Click Here to Manage Email Alerts
Cold forceps polypectomies were effectively noninferior to cold snare polypectomies for complete resection of nonpedunculated polyps <3 mm, and required less time to perform, noted data published in The American Journal of Gastroenterology.
“There have been several small studies that have demonstrated conflicting evidence regarding the efficacy of cold forceps polypectomy for polyps <3 mm,” Mike T. Wei, MD, a gastroenterology/hepatology fellow from Stanford Health Care-Stanford Hospital, told Healio. “As such, we decided to embark on the TINYPOLYP trial, a randomized clinical trial to compare the use of large capacity cold forceps and cold snare in the complete resection of polyps <3 mm.”
To determine whether cold snare polypectomy held an advantage over cold forceps, Wei and colleagues conducted a single-center prospective randomized trial among patients aged >18 years undergoing colonoscopy for any indication. During the colonoscopies, polyps underwent block randomization to removal with cold forceps or cold snare; after polypectomy, two biopsies were taken from the polypectomy margin.
“We found that use of cold forceps was significantly faster to perform compared to cold snare while maintaining a high complete resection rate of 98.3%,” Wei said. “As a result, we feel that cold forceps should be an acceptable alternative to cold snare in removing polyps the size of 3 mm and smaller.”
The cold snare polypectomy required a longer time to perform compared to cold forceps (42.3 vs. 23.2 seconds; P < .001), but cold forceps were likely to require removal of the polyp in more than one piece (15.6% vs. 3.6%; P < .001).
Of 279 nonpedunculated polyps identified to be 3 mm in size or less, 138 were removed with cold snare and 141 were removed by cold forceps.
“In clinical practice, many physicians have opted to remove diminutive polyps using cold forceps,” Wei said. “We feel that when an endoscopist encounters a polyp < 3 mm, either a cold forceps or cold snare can be utilized during the procedure. This can be helpful time- and cost-wise, especially when cold forceps are already used for other purposes, such as during workup for diarrhea or for inflammatory bowel disease surveillance.”
He added: “As we continue to explore techniques in polypectomy during colorectal cancer surveillance, one immediate next step is to evaluate the use of jumbo cold forceps in removing polyps 4 to 5 mm in size.”
Collapse
Read more about
Click Here to Manage Email Alerts