Complete endoscopic removal rate of detected colorectal polyps in a real world out-patient practical setting

• Published in: Scandinavian journal of gastroenterology Vol. 58; no. 4; p. 422
• Main Authors: Shimada, Seitaro, Hotta, Kinichi, Takada, Kazunori, Imai, Kenichiro, Ito, Sayo, Kishida, Yoshihiro, Kawata, Noboru, Yoshida, Masao, Yamamoto, Yoichi, Maeda, Yuki, Minamide, Tatsunori, Ishiwatari, Hirotoshi, Matsubayashi, Hiroyuki, Ono, Hiroyuki
• Format: Journal Article
• Language: English
• Published: England 03.04.2023
• Subjects: Adenoma - surgery; Adult; Aged; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Humans; Middle Aged; Outpatients; Retrospective Studies; resection methods; polyps; Adenoma; colonoscopy
• ISSN: 1502-7708
• DOI: 10.1080/00365521.2022.2132533

Colonoscopy with adenomatous polypectomy reduces the incidence and mortality of colorectal cancer. We introduced a strategy of removing all neoplastic polyps in single-session out-patient colonoscopy using cold polypectomy. We aimed to investigate the achievement of single-session complete removal rate of detected colorectal polyps in clinical practice. This retrospective study included colonoscopy-scheduled 40-79-year-old outpatients, with at least one colorectal neoplasm, between January 2015 and December 2016. Exclusion criteria were: colorectal neoplasms 21 mm or larger in size; pre-examination for colorectal surgery or endoscopic submucosal dissection; colonoscopy performed by health check program; ongoing antithrombotic treatment; inflammatory bowel disease; familial adenomatous polyposis. We defined 'clean colon' as the removal of all detected neoplastic polyps in a single-session colonoscopy. We evaluated clean colon rate, factors relating to clean colon failure and complications. We evaluated 2527 patients (mean age 68 years; 799 women) with 8203 colorectal polyps (7675 adenomas, 423 serrated lesions, 105 Tis and T1 cancers). In 1-4 mm polyps, cold snare polypectomy (CSP; 51.8%) and cold forceps polypectomy (CFP; 45.8%) were applied. Clean colon rates were 95.1% per patient and 97.1% per lesion. The significant factors denoting clean colon failure were inadequate bowel preparation, ≥5 lesions, and the most advanced estimated histology of adenocarcinoma, on multivariate analyses. Post-polypectomy bleeding requiring endoscopic hemostasis occurred in five patients (0.2%) who had undergone endoscopic mucosal resection (EMR) or hot snare polypectomy (HSP). Perforation occurred in one patient (0.04%) with EMR. The clean colon rates were satisfactory in single-session out-patient colonoscopy using cold polypectomy.