A Comparison of the Resection Rate of Cold Snare Polypectomy for Large (10-15 mm) and Small (5-9 mm) Colorectal Polyps
Condition: Adenomatous Polyps
MeSH terms: Adenomatous Polyps; Polyps
Study type: Interventional

Summary: 
      Colorectal cancer remains the third most common cause of death from cancer worldwide.
      Colonoscopy allows removal of adenomatous polyps is the best colorectal cancer screening,
      according to the adenoma-carcinoma sequence. Recent studies have reported approximately 30%
      of interval cancer may be incomplete polyp resection. Complete polyp resection may be
      particularly important when implementing new methods for surveillance colonoscopies. Cold
      snare polypectomy (CSP) is considered to be a safer procedure for removing subcentimeter
      lesions than conventional hot snare polypectomy (HSP). CSP removal of polyps sized ≤5 mm have
      recommended by the European Society of Gastrointestinal Endoscopy guideline as the preferred
      technique. Previous report said that the complete resection rate of CSP for adenomatous
      polyps 4-9 mm in size was comparable to that of HSP, and in the foreseeable future CSP can be
      one of the standard techniques for 4-9 mm colorectal polyps. However, data on complete
      resection of colorectal polyps 1.0-1.5 mm in size is sparse. Investigators are interested in
      comparison of the resection rate of cold snare polypectomy for large (10-15 mm) and small
      (5-9 mm) colorectal polyps using CSP.
    

Detailed description: 
      Participantswho meet inclusion criteria will be asked to participate, investigators will
      include all patients with resectable polyps, but only adenomatous polyps will be included for
      analysis. See also inclusion and exclusion criteria.

      Colonoscopy, after bowel preparation with polyethylene glycol solution was performed using
      standard colonoscopes (CF-HQ290I, CF-Q260AI) and polypectomy snares(13mm Captivator and 10mm
      Captivator II).

      All procedures were performed by experienced endoscopists (each with over 1000 colonoscopies
      performed) including CSP. All polyps between 5 and 15mm will be removed with a polypectomy
      snare. Polyp size will be measured using the tip of the snare catheter (2.5mm). Difficulty of
      resection will be grade by polyp resection time. Following the resection, jet stream of water
      will be used to wash mucosal defect thoroughly. After endoscopist's attestation that polyp
      removal was complete by carefully observe the resection margins with near focus mode, for
      large lesions (10-15mm) 4 biopsies will be performed from all four quadrants of resection
      margins, for small lesions (5-9mm) biopsies were performed from two marginal sites located
      symmetrically on the left and right of the mucosal defects to confirm residual polyp tissue.

      If polyp resection is complicated by bleeding (not self-sustained), no biopsies will be taken
      and any additional polyps that will be found during the remaining examination will be
      excluded from analysis. Severe bleeding that will complicate resection margins examination
      will be excluded from analysis, Endoscopic haemostasis will be performed when active
      haemorrhage continued for ≥30s.

      A single research subject may have many eligible polyps. To avoid taking many biopsies, the
      investigators will not include more than 5 eligible polyps (the first 5 that are detected)
      per patient in the study.

      Laboratory Analysis:

      The polyps will be evaluated by experienced pathologists according to Vienna classification.
      Resection margins for each polyp will be recorded as: R0= adenomatous tissue free,
      R1=adenomatous tissue detection. Investigators will only include adenomatous polyps in the
      analysis. for financial requests of the resection margin biopsies. The pathological diagnosis
      of the biopsies will become part of the medical record. If biopsies contain adenomatous
      tissue the participants will be ask to return for a follow-up colonoscopy within six month.
    

Intervention name(s): Cold snare polypectomy
Intervention type(s): Other
Intervention description(s): cold snare polypectomy (CSP), which does not include electrocautery to do a polypectomy with a snare
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Cold snare polypectomy; Colorectal polyps; CARE Study