Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10-14 mm in diameter.
OBJECTIVE
Cold snare polypectomy (CSP) is commonly used for treating colorectal polyps <10 mm in diameter. We evaluated the analysis and safety of CSP for larger polyps.


METHODS
We retrospectively analyzed 1006 colorectal polyps resected with CSP. Indication for CSP was polyps 2-14 mm that were diagnosed as benign neoplastic polyp by magnifying endoscopy. Various clinicopathological characteristics were analyzed. Multivariate analyses were used to determine the independent risk factors for failure of complete CSP resection. With respect to polyp size, we compared the therapeutic outcomes between polyps <10 mm and ≥10 mm. Additionally, the presence of muscularis mucosa in resected specimens was analyzed.


RESULTS
Rates of en bloc resection and postoperative hemorrhage were 98.8% and 0.1%, respectively. Seven hundred and ninety-one neoplastic lesions were analyzed and negative margins were found in 70.5% of the lesions, Multivariate analysis showed that non-polypoid morphology, histology of intramucosal cancer + high-grade adenoma and sessile serrated adenoma and polyp were significant factors for incomplete resection. With respect to the difference between lesions ≥10 mm than in those <10 mm, rates of cancer and positive/unclear margins were significantly higher (5.0% vs 0.9%, P < 0.001; 40.6% vs 27.7%, P = 0.007) in the ≥10 mm with rates of postoperative hemorrhage not significantly different (0.8% vs 0.0%). Additionally, the loss of muscularis mucosa was found in 27.8% of all lesions.


CONCLUSIONS
CSP is a safe procedure for polyps 2-14 mm. However, CSP has limitations in terms of the histopathological margin and loss of muscularis mucosa in specimens.
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ryohei
R
Hirose
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Naohisa
http://orcid.org/0000-0001-6167-9705
N
Yoshida
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Takaaki
T
Murakami
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Kiyoshi
K
Ogiso
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yutaka
Y
Inada
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Osamu
O
Dohi
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Tetsuya
T
Okayama
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Kazuhiro
K
Kamada
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Kazuhiko
K
Uchiyama
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Osamu
O
Handa
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Takeshi
T
Ishikawa
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideyuki
H
Konishi
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yuji
Y
Naito
Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yasuko
Y
Fujita
Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Mitsuo
M
Kishimoto
Department of Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Akio
A
Yanagisawa
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yoshito
Y
Itoh
D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome
cold snare polypectomy; colorectal polyp; histopathological margin; large polyps