Comparison of Jumbo and Hot Biopsy Forceps
Condition: Colonoscopy; Polypectomy
Study type: Interventional

Summary: 
      -  Cold forceps polypectomy and hot biopsy forceps electrocauterization (HBF) are still
           widely used methods for endoscopic resection of diminutive colorectal polyps
           (DCPs)(polyps smaller than 5 mm). Jumbo forceps may be more effective in the removal of
           DCPs because of their larger size.

        -  This was a prospective study of consecutive patients undergoing colonoscopy and found to
           have at least one diminutive polyp. One experienced endoscopist removed DCPs using
           either jumbo or hot biopsy forceps.

        -  Aim was to evaluate the histological quality and adequacy of the DCPs resected using
           jumbo forceps in comparison with HBF.
    

Detailed description: 
      -  Exclusion criteria were (i) having abnormal coagulation parameters and thrombocytopenia,
           taking aspirin or other medications which could affect bleeding time, (ii) history of
           inflammatory bowel disease, (iii) pregnancy.

        -  One experienced endoscopist carried out all the procedures using the same techniques.

        -  If a diminutive polyp was detected during colonoscopy, and it was estimated that the
           polyp was eligible for the study, the patient was randomly assigned by the physician to
           one of the two forceps groups (hot biopsy versus jumbo forceps) using a flipping coin
           method. Polypectomy was then performed with the intention to remove all polypoid tissue
           with one forceps bite. After the initial bite was obtained, the polypectomy site was
           observed with visual inspection. If residual polypoid tissue was observed after the
           first bite, additional biopsies were taken until visual eradication was attained.

        -  The size of the polyp was estimated during colonoscopy by visual comparison with the
           open biopsy forceps (Open-biopsy forceps technique). Polypectomies were performed using
           jumbo forceps (Conmed, USA) and hot biopsy forceps (Wilson-Cook Medical, USA). For HBF,
           the technique was based on the procedure first described in 1973, as follows: slight
           pulling force was applied to the polyp and then the electrocautery current was applied
           until the white coagulum was seen at the polyp base. The technique for jumbo forceps was
           as follows: after initial grasping, slight force was applied until the polyp was
           separated from the stalk. The electrocautery current waveform and intensity settings
           were the same for each patient. Each biopsy specimen was placed in a separate formalin
           solution.

        -  An experienced blinded pathologist evaluated the tissue samples for depth of specimen,
           amount of cautery damage (for hot biopsy forceps) or crush artifacts (for jumbo
           forceps), architecture, fragmentation, overall diagnostic quality, evaluation and
           positivity of surgical margins.

        -  All statistical analyses were performed using SPSS for Windows v. 15 (SPSS Inc.,
           Chicago, IL, USA). Demographic, biochemical and histopathological features were
           classified as continuous or categorical variables. Kolmogorov-Smirnov analysis was used
           to test for Gaussian distribution. The data were expressed as arithmetic mean ± standard
           deviation (SD), since the evaluated variables were Gaussian-distributed. Comparisons
           between two groups were performed using the Student's t-test for continuous variables.
           Categorical variables were compared using the χ2 test (2X2, 3X2 and 4X2 tables) and
           Fisher's exact test. When the chi-square test was used, Yates' correction for continuity
           was used. All reported p-values were two-tailed, and those less than 0.05 were
           considered to be statistically significant.
    

Intervention name(s): Jumbo forceps; Hot biopsy forceps
Intervention type(s): Device; Device
Intervention description(s): comparison of different polypectomy devices; comparison of different polypectomy devices
Other intervention name(s): Jumbo forceps (Conmed, USA); Hot biopsy forceps (Wilson-Cook Medical, USA)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Cold forceps polypectomy; Diminutive colorectal polyp; Hot biopsy forceps electrocauterization; Jumbo forceps.