Cold Snare,Hot Snare and APC Polypectomy for the Complete Removal of Small Left Sided Colon Polyps
Condition: Colonic Polyps
MeSH terms: Polyps; Colonic Polyps
Study type: Observational

Summary: 
      Given the limited existing data regarding the advantages and limitations of the existing
      techniques in the removal of colonic polyps the investigators designed a prospective study in
      order to compare cold snare vs hot snare vs argon plasma coagulation for the compete removal
      of colonic polyps of the left colon up to a diameter of 0.8cm.
    

Detailed description: 
      Adenomatous polyps are the most common neoplastic findings discovered in subjects who undergo
      colonoscopy either for colorectal screening or during a diagnostic work-up for symptoms.

      Currently small polyps 0.3-0.8cm are removed using hot snare polypectomy (HSP) cold snare
      polypectomy (CSP) while argon plasma coagulation (APC) has been proposed for the
      cauterization of bigger polyps ("Melt Effect") Endoscopic polypectomy is associated with
      potential complications, i.e. perforation and bleeding while some polyps may recur after
      polypectomy.

      Given the limited existing data regarding the advantages and limitations of the existing
      techniques in the removal of colonic polyps the investigators designed a prospective study in
      order to compare the above mentioned methods for the compete removal of colonic polyps
      0,3-0,8 cm from the left side colon.

      METHODS The study will be conducted in the endoscopy unit of "Evangelismos" Hospital and in D
      Surgical clinic of the University Hospital "Attikon".All consecutive patients with colorectal
      polyps of the left colon (up to the splenic flexure) with a diameter of 0.3-0.8cm will be
      prospectively randomized to three groups.

        1. CSP: In this group polyps will be removed with the cold snare polypectomy technique, as
           a single piece. Additionally, a 1-2mm of normal tissue around the small polyp will also
           be ensnared in the CSP.

        2. HSP: In this group polyps will be removed with the hot snare polypectomy technique as a
           single piece with a electrosurgical snare and monopolar current with a setting of 30-35
           W in the endocut function.

        3. APC: In APC group polyps will be cauterized by application of high power argon plasma
           coagulation on small waves at 50-60W and flow at 2lt/min.

      All polyps will be elevated by submucosal injection of normal saline (1ml) and consequently a
      special dye (1ml) containing carbon particles (Spot) before applying any of the three removal
      techniques.

      The injection solution protects from thermal injury of deeper layers during the application
      of current and APC,also the injection of the dye (tattoo) at the polypectomy, ensures that
      the endoscopist will detect the point of polypectomy in the follow up colonoscopy after 3-6
      months.

      Spot (GI supply,Camp Hill,PA) is the only commercially available suspension for endoscopic
      tattooing approved by the Food and Drug Association (FDA). It contains prediluted sterile
      syrings that are filled with highly purified fine carbon particles ready for endoscopic use.

      The study excluded patients with a history of familial polyposis (FAP), Gardner's syndrome,
      Peutz-Jeghers syndrome, patients with colon Cancer as well as patients with idiopathic
      inflammatory bowel disease (IBD).

      Statistical analysis showed that the sample required to give medium (W = 0.3) the difference
      between the three groups is 108 patients, with significance level of 5% and validity of the
      study 80% All patients included in the study will undergo a repeat colonoscopy in a 3-6 month
      time period. The endoscopist based on tattoos have been received on the first endoscopy
      during polypectomy will receive multiple biopsies from the point, which will be sent for
      histological examination.The pathologist will then examine the tissue sample and will define
      whereas the polyp has been completely eradicated or recurred.
    

Intervention name(s): polypectomy
Intervention type(s): Procedure
Intervention description(s): Polyps size up to 0.8 cm will removed from the left colon.Re examination in 6 months period with biopsy from the scar of polypectomy.
Other intervention name(s): sigmoidoscopy; colonoscopy
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All patients with colonic left sided small polyps
      
Biospecimen description: 
      colonic polyps tissue samples
    
Keywords: cold snare polypectomy; APC; hot snare polypectomy