A comparison of the resection rate for cold and hot snare polypectomy for 4-9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study)

Takuji Kawamura, Yoji Takeuchi, Satoshi Asai, Isao Yokota, Eisuke Akamine, Minoru Kato, Takuji Akamatsu, Kazuhiro Tada, Yoriaki Komeda, Mineo Iwatate, Ken Kawakami, Michiko Nishikawa, Daisuke Watanabe, Atsushi Yamauchi, Norimasa Fukata, Masaaki Shimatani, Makoto Ooi, Koichi Fujita, Yasushi Sano, Hiroshi Kashida, Satoru Hirose, Hiroyoshi Iwagami, Noriya Uedo, Satoshi Teramukai, Kiyohito Tanaka, Takuji Kawamura, Yoji Takeuchi, Satoshi Asai, Isao Yokota, Eisuke Akamine, Minoru Kato, Takuji Akamatsu, Kazuhiro Tada, Yoriaki Komeda, Mineo Iwatate, Ken Kawakami, Michiko Nishikawa, Daisuke Watanabe, Atsushi Yamauchi, Norimasa Fukata, Masaaki Shimatani, Makoto Ooi, Koichi Fujita, Yasushi Sano, Hiroshi Kashida, Satoru Hirose, Hiroyoshi Iwagami, Noriya Uedo, Satoshi Teramukai, Kiyohito Tanaka

Abstract

Objective: To investigate the success rate of cold snare polypectomy (CSP) for complete resection of 4-9 mm colorectal adenomatous polyps compared with that of hot snare polypectomy (HSP).

Design: A prospective, multicentre, randomised controlled, parallel, non-inferiority trial conducted in 12 Japanese endoscopy units. Endoscopically diagnosed sessile adenomatous polyps, 4-9 mm in size, were randomly assigned to the CSP or HSP group. After complete removal of the polyp using the allocated technique, biopsy specimens from the resection margin after polypectomy were obtained. The primary endpoint was the complete resection rate, defined as no evidence of adenomatous tissue in the biopsied specimens, among all pathologically confirmed adenomatous polyps.

Results: A total of 796 eligible polyps were detected in 538 of 912 patients screened for eligibility between September 2015 and August 2016. The complete resection rate for CSP was 98.2% compared with 97.4% for HSP. The non-inferiority of CSP for complete resection compared with HSP was confirmed by the +0.8% (90% CI -1.0 to 2.7) complete resection rate (non-inferiority p<0.0001). Postoperative bleeding requiring endoscopic haemostasis occurred only in the HSP group (0.5%, 2 of 402 polyps).

Conclusions: The complete resection rate for CSP is not inferior to that for HSP. CSP can be one of the standard techniques for 4-9 mm colorectal polyps. (Study registration: UMIN000018328).

Keywords: colonic polyps; colonoscopy; colorectal Cancer; colorectal neoplasm; endoscopy.

Conflict of interest statement

Competing interests: This study was funded by the Investigator Sponsored Research Program of Boston Scientific. The funder paid for statistical analysis, construction of electronic data collecting system and English proofreading service. However, the funder was not involved in the study design, recruitment, analysis plan or interpretation of data.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study procedure for CSP. A flat elevated type polyp detected in the colon (A). The Captivator II polypectomy snare, 10 mm in size, was used for CSP. The size of this polyp was estimated to be 8 mm (B). CSP was performed (C). Biopsies were performed from two marginal sites located symmetrically on the left and right of the mucosal defects to confirm residual polyp tissue (D). CSP, cold snare polypectomy.
Figure 2
Figure 2
Study flow.†Including hot/cold snare polypectomy overlap cases (n=124).‡Including hot/cold snare polypectomy overlap cases (n=102).

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