title: Polypectomy practices of sub-centimeter polyps in the English Bowel Cancer Screening Programme.
abstract: BACKGROUND
  Most colonic polyps are small, and several polypectomy techniques are available. We aimed to describe the variation in polypectomy techniques employed for the removal of sub-centimeter polyps in relation to polyp characteristics, completeness of histological excision and safety.
  
  
  METHODS
  Prospectively collected data relating to the removal of sub-centimeter polyps over a 3-year period (between January 2010 and December 2012) were retrieved from the English Bowel Cancer Screening Programme.
  
  
  RESULTS
  A total of 147,174 sub-centimeter polyps were removed during 62,679 procedures. For pedunculated polyps, hot snare was most common in the left (median 92 %, IQR 83.3-97.0 %) and right colon (median 75 %, IQR 3-92 %). For non-pedunculated polyps, cold snare was most common in the right colon (median 24 %, IQR 9-47 %); whereas hot snare remained most common in the left colon (median 32 %, IQR 19-49 %). Surgeons were more likely than physicians to use diathermy-assisted techniques (65.6 vs. 56.5 %, p < 0.001). Twelve (0.03 %) bleeding episodes required transfusion with no polypectomy technique dominating and 16 (0.04 %) perforations with 81 % of polypectomies performed using diathermy-assisted techniques. There was substantial variation between screening centers for the completeness of histological excision. For non-pedunculated polyps, histologically confirmed complete excision was more after EMR (23.4 %) compared with other techniques (cold biopsy forceps 17.7 %, cold snare 15.1 %, hot biopsy forceps 19.1 %, hot snare 21.5 %). The use of cold techniques and EMR has increased over time, whereas the use of hot biopsy forceps and hot snare has decreased (p < 0.001).
  
  
  CONCLUSIONS
  The removal of sub-centimeter polyps within the BCSP is safe despite wide variations in practice. The use of cold resection techniques and EMR has increased over time. The histological assessment for completeness of excision is limited and should be confirmed endoscopically at the time of polypectomy.
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK. said.din1@nhs.net.|Department of Oncology, University of Sheffield Medical School, Sheffield, UK. said.din1@nhs.net.
authors.forename: Said
authors.initials: S
authors.lastname: Din
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.|Department of Oncology, University of Sheffield Medical School, Sheffield, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Ball
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Taylor
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK.|Durham University Medicine, Durham, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rutter
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Riley
authors.affiliation: Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, UK.
authors.forename: Shawinder
authors.initials: S
authors.lastname: Johal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom
keywords: Adverse events; Colonoscopy; Polypectomy; Sub-centimeter polyps