title: Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy.
abstract: OBJECTIVE
  To compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps.
  
  
  METHODS
  This prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures wereen-blocresection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn't routinely performed.
  
  
  RESULTS
  Two hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). Theen-blocresection rate was significantly higher with CSP than with HFB [99.3% (147/148)vs80.0% (108/135),P< 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148)vs47.4% (64/135),P< 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148)vs8.1% (11/135),P= 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135)vs1.3% (2/148),P< 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).
  
  
  CONCLUSIONS
  CSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Yoriaki
authors.initials: Y
authors.lastname: Komeda
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kashida
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: George
authors.initials: G
authors.lastname: Tribonias
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kono
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Mitsunari
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Adachi
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Mine
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nagai
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Asakuma
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Hagiwara
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Shigenaga
authors.initials: S
authors.lastname: Matsui
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Chikugo
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Chiba
authors.affiliation: Yoriaki Komeda, Hiroshi Kashida, Toshiharu Sakurai, George Tribonias, Kazuki Okamoto, Masashi Kono, Mitsunari Yamada, Teppei Adachi, Hiromasa Mine, Tomoyuki Nagai, Yutaka Asakuma, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Masayuki Kitano, Takaaki Chikugo, Yasutaka Chiba, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
mesh_terms: D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods; D006358:Hot Temperature; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: Cold snare polypectomy; Colonoscopy; Colorectal diminutive polyps; Hot forceps biopsy; Polypectomy