Skip to main content

Advertisement

SpringerLink
Log in

Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study

  • Original Article—Alimentary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The clinical course and surveillance strategy for patients who undergo cold snare polypectomy (CSP) for high-grade dysplasia (HGD) or cancer is unclear. We investigated the management of colorectal HGDs and cancers following CSP.

Methods

This Japanese nationwide multicenter exploratory study was retrospectively conducted on patients who had undergone CSP for colorectal HGDs or cancers and follow-up colonoscopy at least once from 2014 to 2020. We investigated the detection rate of CSP scars, local recurrence rate (LRR), risk factors for local recurrence, and follow-up strategy. This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000043670).

Results

We included 155 patients with 156 lesions. CSP scars were identified in 22 (31.4%), 41 (54.7%), and 10 (90.9%) patients with curative, borderline, and non-curative resection, respectively. Among them, residual tumors were observed in one (4.5%), six (14.6%), and three (30.0%) cases, respectively. The total LRR was 13.7% (95% confidence interval: 6.8–23.8). R1 resection cases (either horizontal or vertical margins positive for tumors) were associated with local recurrence (p = 0.031). Salvage endoscopic and surgical resections were performed on 21 and 10 patients, respectively. Among them, the proportion of endoscopically suspected residual tumors was significantly higher (p < 0.001) in the residual tumor-positive group (100%) than in the residual tumor-negative group (28.6%).

Conclusions

LRR after CSP for HGDs or cancers was 13.7% based on scar-identified cases. Salvage endoscopic or surgical resection should be performed according to the curability of the lesion and endoscopic findings during colonoscopic surveillance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

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;329:1977–81.

    Article  CAS  PubMed  Google Scholar 

  2. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Saito Y, Oka S, Kawamura T, et al. Colonoscopy screening and surveillance guidelines. Dig Endosc. 2021;33:486–519.

    Article  PubMed  Google Scholar 

  4. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49:270–97.

    Article  PubMed  Google Scholar 

  5. Kaltenbach T, Anderson JC, Burke CA, et al. Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2020;91:486–519.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Horiuchi A, Nakayama Y, Kajiyama M, et al. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc. 2014;79:417–23.

    Article  PubMed  Google Scholar 

  8. Takeuchi Y, Yamashina T, Matsuura N, et al. Feasibility of cold snare polypectomy in Japan: a pilot study. World J Gastrointest Endosc. 2015;7:1250–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Suzuki S, Gotoda T, Kusano C, et al. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc. 2018;87:1095–103.

    Article  PubMed  Google Scholar 

  10. Ito A, Suga T, Ota H, et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol. 2018;53:1171–8.

    Article  PubMed  Google Scholar 

  11. Matsuura N, Takeuchi Y, Yamashina T, et al. Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study. Endoscopy. 2017;49:251–7.

    Article  PubMed  Google Scholar 

  12. Shichijo S, Takeuchi Y, Kitamura M, et al. Does cold snare polypectomy completely resect the mucosal layer? A prospective single-center observational trial. J Gastroenterol Hepatol. 2020;35:241–8.

    Article  PubMed  Google Scholar 

  13. Tanaka S, Saitoh Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2021;56:323–35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hirose R, Yoshida N, Murakami T, et al. Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10–14 mm in diameter. Dig Endosc. 2017;29:594–601.

    Article  PubMed  Google Scholar 

  15. Kobayashi S, Yamada M, Takamaru H, et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United Eur Gastroenterol J. 2019;7:914–23.

    Article  CAS  Google Scholar 

  16. Minoda Y, Ogino H, Chinen T, et al. Objective validity of the Japan Narrow-Band Imaging Expert Team classification system for the differential diagnosis of colorectal polyps. Dig Endosc. 2019;31:544–51.

    Article  PubMed  Google Scholar 

  17. Murano T, Ikematsu H, Shinmura K, et al. Endoscopic prediction of advanced histology in colorectal lesions sized <10 mm using the Japan Narrow-band imaging Expert Team classification. Dig Endosc. 2020;32:785–90.

    Article  PubMed  Google Scholar 

  18. Barge W, Kumar D, Giusto D, et al. Alternative approaches to polyp extraction in colonoscopy: a proof of principle study. Gastrointest Endosc. 2018;88:536–41.

    Article  PubMed  Google Scholar 

  19. Rutter MD, Beintaris I, Valori R, et al. World endoscopy organization consensus statements on post-colonoscopy and post-imaging colorectal cancer. Gastroenterology. 2018;155:909-25.e3.

    Article  PubMed  Google Scholar 

  20. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d English edition [secondary publication]. J Anus Rectum Colon. 2019;3:175–95.

    Article  PubMed Central  Google Scholar 

  21. Maruoka D, Arai M, Akizue N, et al. Residual adenoma after cold snare polypectomy for small colorectal adenomas: a prospective clinical study. Endoscopy. 2018;50:693–700.

    Article  PubMed  Google Scholar 

  22. Belderbos TD, Leenders M, Moons LM, et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014;46:388–402.

    Article  PubMed  Google Scholar 

  23. Djinbachian R, Iratni R, Durand M, et al. Rates of incomplete resection of 1- to 20-mm colorectal polyps: a systematic review and meta-analysis. Gastroenterology. 2020;159:904-14.e12.

    Article  PubMed  Google Scholar 

  24. Tanaka H, Oka S, Tanaka S, et al. Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: large multicenter 10-year study. Dig Endosc. 2021;33:608–15.

    Article  PubMed  Google Scholar 

  25. Katagiri A, Inoki K, Konda K, et al. Case of colorectal cancer after cold snare polypectomy successfully salvaged on endoscopic submucosal dissection. Cureus. 2020;12: e11182.

    PubMed  PubMed Central  Google Scholar 

  26. Kato M, Shiraishi J, Uraoka T. Second local recurrence with advanced rectal cancer after salvage endoscopic mucosal resection of local recurrence following initial cold polypectomy. Dig Endosc. 2017;29:636.

    Article  PubMed  Google Scholar 

  27. Horiuchi A, Ikuse T, Tanaka N. Cold snare polypectomy: indications, devices, techniques, outcomes and future. Dig Endosc. 2019;31:372–7.

    Article  PubMed  Google Scholar 

  28. Abe Y, Nabeta H, Koyanagi R, et al. Extended cold snare polypectomy for small colorectal polyps increases the R0 resection rate. Endosc Int Open. 2018;6:E254–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ma X, Feng X, Li Y, et al. A comparison of incomplete resection rate of large and small colorectal polyps by cold snare polypectomy. Clin Gastroenterol Hepatol. 2022;20:1163–70.

    Article  CAS  PubMed  Google Scholar 

  30. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National polyp study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371–9.

    PubMed  Google Scholar 

  31. Din S, Ball AJ, Riley SA, et al. Cold snare polypectomy: does snare type influence outcomes? Dig Endosc. 2015;27:603–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Izumi Hisada, Dr. Naoto Tamai, Dr. Akito Ookubo, Dr. Eiji Kamba, Dr. Shinichi Hashimoto, Dr. Takahiko Nakamura, Dr. Kei Nishioka, Dr. Ishikawa Tsubasa, Dr. Keisuke Nakai, Dr. Takashi Murakami, and Dr. Akiho Hirotada for their help with data collection. This study received no funding.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8666, Japan

    Kazuya Inoki & Atsushi Katagiri

  2. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan

    Hiroyuki Takamaru

  3. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Hiroto Furuhashi

  4. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan

    Yoshihiro Kishida

  5. Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan

    Yuichi Shimodate

  6. Department of Gastroenterology, National Hospital Organization, Kyushu Medical Center, Clinical Research Institute, 1-8-1 Jigyouhama, Chuo-Ku, Fukuoka City, Fukuoka, 810-8563, Japan

    Yorinobu Sumida

  7. Department of Gastroenterology, Kobe City Medical Center, General Hospital, 2-1-1 Minatojima Minamicho, Chuo-Ku, Kobe City, Hyogo, 650-0047, Japan

    Kazuya Hosotani

  8. Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan

    Hiroya Ueyama

  9. Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-Ku, Tokyo, 130-8575, Japan

    Yohei Furumoto

  10. Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1, MinamiKogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan

    Shinichi Hashimoto

  11. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Yoji Takeuchi

  12. Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-Kami-Machi, Itabashi-Ku, Tokyo, 173-8610, Japan

    Ryoji Ichijima & Takuji Gotoda

  13. Department of Gastroenterology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-Ku, Hamamatsu-Shi, Shizuoka, 430-8558, Japan

    Yashiro Yoshizawa

  14. Department of Endoscopy, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, 260-8717, Japan

    Takuto Suzuki

  15. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan

    Yosuke Minoda & Mitsuru Esaki

  16. Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu City, Oita, 879-5593, Japan

    Kazuhiro Mizukami

  17. Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan

    Tomoaki Matsumura

  18. Department of Gastroenterology, Fukaya Red Cross Hospital, 5-8-1, Kamishibachonishi, Fukaya City, Saitama, 366-0052, Japan

    Toyotaka Kasai

  19. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya City, Aichi, 466-8560, Japan

    Takeshi Yamamura

  20. Department of Gastroenterology and Hepatology, Shunkaikai Inoue Hospital, 6-12, Takaramachi, Nagasaki City, Nagasaki, 850-0045, Japan

    Ken Ohnita

  21. Division of Gastroenterology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan

    Ken Hara

  22. Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku Kokurakita-Ku, Kitakyushu City, Fukuoka, 802-8561, Japan

    Mitsuru Esaki

  23. Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan

    Hideki Ishikawa

Authors
  1. Kazuya Inoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroyuki Takamaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroto Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshihiro Kishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuichi Shimodate
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yorinobu Sumida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuya Hosotani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroya Ueyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yohei Furumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shinichi Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoji Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ryoji Ichijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yashiro Yoshizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Takuto Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yosuke Minoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Kazuhiro Mizukami
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tomoaki Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Toyotaka Kasai
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Takeshi Yamamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ken Ohnita
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Ken Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Mitsuru Esaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Atsushi Katagiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Hideki Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Takuji Gotoda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KI, HT, HF, YK, YS, YS, KH, HU, YF, SH, YT, RI, YY, TS, YM, KM, TI, TK, TY, KO, KH, ME, AK, YT, HI, and TG. The first draft of the manuscript was written by KI and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazuya Inoki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Inoki, K., Takamaru, H., Furuhashi, H. et al. Management of colorectal high-grade dysplasia or cancer resected by cold snare polypectomy: a multicenter exploratory study. J Gastroenterol 58, 554–564 (2023). https://doi.org/10.1007/s00535-023-01980-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-023-01980-1

Keywords

Search

Navigation