A survey of colonoscopic polypectomy practice amongst Israeli gastroenterologists

Dan Carter, Marc Beer-Gabel, Andrew Zbar, Benjamin Avidan, Eytan Bardan, Dan Carter, Marc Beer-Gabel, Andrew Zbar, Benjamin Avidan, Eytan Bardan

Abstract

Background: Polypectomy techniques have been implicated as factors in the effectiveness of polyp resection. The range of polypectomy practices among gastroenterologists in Israel is unknown.

Methods: A structured survey was sent to all Israeli gastroenterology departments in all 15 major academic hospitals and to 3 central outpatient clinics.

Results: The survey was completed by 100 clinicians (45% contacted) derived from 13 of 15 academic centers (85%) and from all 3 outpatient clinics. Significant differences were noted in the preferred polypectomy for the resection of polyps 1-3 mm and 7-9 mm in diameter whereas for those polyps 4-6 mm in diameter, both the hot forceps and hot snare were most commonly used technique. Coagulation was employed in 42% of cases, pure cutting in 20% and blend current in 38% of cases. Narrow band imaging was used by 54% of practitioners, and only 33% of gastroenterologists regularly used dye spraying techniques. When removing pedunculated polyps >1 cm in diameter, 75% did not use any specific measures designed to prevent perforation or hemorrhage. Performance of >300 colonoscopies per year was associated with a greater use of dye spraying techniques and working in a hospital was more likely to be accompanied by clip deployment to larger polypectomy stalks as part of the procedure.

Conclusion: Our results demonstrate considerable heterogeneity in the techniques used for removal of polyps <1 cm. Most practitioners do not regularly use advanced techniques for polyp detection or for the prevention of post-polypectomy bleeding.

Keywords: Colonoscopic polypectomy; practice survey.

Conflict of interest statement

Conflict of Interest: None

References

    1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.
    1. Citarda F, Tomaselli G, Capocaccia R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–815.
    1. Brenner H, Chang-Claude J, Seiler CM, et al. Protection from colorectal cancer after colonoscopy: a population-based case control study. Ann Intern Med. 2011;154:22–30.
    1. Waye JD. Techniques of polypectomy: hot biopsy forceps and snare polypectomy. Am J Gastroenterol. 1987;82:615–618.
    1. Fry LC, Lazenby AJ, Mikalenko I, et al. Diagnostic quality of polyps resected by snare polypectomy: does the type of electrosurgical current matter? Am J Gastroenterol. 2006;101:2123–2127.
    1. Fyock CJ, Draganov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2007;16:3630–3637.
    1. Parra-Blanco A, Kaminaga N, Kojima T, et al. Colonoscopic polypectomy with cutting current: is it safe? Gastrointest Endosc. 2000;51:676–681.
    1. Fatima H, Rex DK. Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am. 2007;17:145–156.
    1. Kim Do H, Lim SW. Analysis of delayed polypectomy bleeding in a colorectal unit. J Kor Soc Coloproctol. 2011;27:13–16.
    1. Katsinelos P, Chatzimavroudis G, Papaziogas B, et al. Endoclippingassisted resection of large colorectal polyps. Surg Laparosc Endosc Percutan Tech. 2008;18:19–23.
    1. Ichise Y, Horiuchi A, Nakayama Y, et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2011;84:78–81.
    1. Paspatis GA, Tribonias G, Konstantinidis K, et al. A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps. Colorectal Dis. 2011;13:e345–e348.
    1. Watabe H, Yamaji Y, Okamoto M, et al. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006;64:73–78.
    1. Friedland S, Sedehi D, Soetikno R. Colonoscopic polypectomy in anticoagulated patients. World J Gastroenterol. 2009;15:1973–1976.
    1. Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004;60:414–418.
    1. Heresbach D, Kornhauser R, Seyrig JA, et al. A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia. Endoscopy. 2010;42:806–813.
    1. Woods A, Sanowski RA, Wadas DD, et al. Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal. Gastrointest Endosc. 1989;35:536–540.
    1. Efthymiou M, Taylor AC, Desmond PV, et al. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011;43:312–316.
    1. Tappero G, Gaia E, De Giuli P, et al. Cold snare excision of small colorectal polyps. Gastroinest Endosc. 1992;38:310–313.
    1. Zlatanic J, Waye JD, Kim PS, et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastroinetst Endosc. 1999;49:731–735.
    1. Gilbert DA, DiMarino AJ, Jensen DM, et al. Status evaluation: hot biopsy forceps. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee. Gastrointest Endosc. 1992;38:753–756.
    1. Van Gossum A, Cozzoli A, Adler, et al. Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992;38:472–475.
    1. Kim HS, Kim TI, Kim WH, et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol. 2006;101:1333–1341.
    1. Rey JF, Beilenhoff U, Neumann CS, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy. 2010;42:764–772.
    1. Williams CB. Small polyps: the virtues and the dangers of hot biopsy. Gastrointest Endosc. 1991;37:394–395.
    1. Tolliver KA, Rex DK. Colonoscopic polypectomy. Gastroenterol Clin N Am. 2008;37:229–251.
    1. Ellis K, Schiele M, Marquis S, et al. Efficacy of hot biopsy forceps, cold micro-snare and micro-square with cautery techniques in the removal of diminutive colonic polyps. Gastrointest Endosc. 2007;45:AB107.
    1. Ichise Y, Horiuchi A, Nakayama Y, et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion. 2001;84:78–81.
    1. Hewett DG, Rex DK. Colonoscopy and diminutive polyps: hot or cold biopsy or snare?. Do I send to pathology? Clin Gastroenterol Hepatol. 2011;9:102–105.
    1. Friedland S, Sedehi D, Soetikno R. Colonoscopic polypectomy in anticoagulated patients. World J Gastroenterol. 2009;15:1973–1976.
    1. Mönkemüller K, Neumann H, Fry LC, et al. Polypectomy techniques for difficult colon polyps. Dig Dis. 2008;26:342–346.
    1. Dobrowolski S, Dobosz M, Babicki A, et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2006;63:1004–1009.
    1. Arora G, Mannalithara A, Singh G, et al. Risk of perforation from a colonoscopy in adults: a large population-based study. Gastrointest Endosc. 2009;69:654–664.
    1. Iishi H, Tatsuta M, Kitamura S, et al. Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique. Hepatogastroenterology. 1997;44:698–702.
    1. Hsieh YH, Lin HJ, Tseng GY, et al. Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study. Hepatogastroenterology. 2001;48:1379–1382.
    1. Dobrowolski S, Dobosz M, Babicki A, et al. Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study. Surg Endosc. 2004;18:990–993.
    1. Hixson LJ, Fennerty MB, Sampliner RE, et al. Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. Gastrointest Endosc. 2001;37:125–127.
    1. van Rijn JC, Reitsma JB, Stoker J, et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006;101:343–350.
    1. Buchner AM, Shahid MW, Heckman MG, et al. High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. Clin Gastroenterol Hepatol. 2010;8:364–370.
    1. Wada Y, Kudo SE, Kashida H, et al. Diagnosis of colorectal lesions with the magnifying, narrow-band imaging system. Gastrointest Endosc. 2009;70:522–531.
    1. Kiesslich R, von Bergh M, Hahn M, et al. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy. 2011;33:1001–1006.
    1. van den Broek FJ, Reitsma JB, Curvers WL, et al. Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos) Gastrointest Endosc. 2009;69:124–135.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere