Complete endoscopic removal rate of detected colorectal polyps in a real world out-patient practical setting

Abstract

Objectives

Colonoscopy with adenomatous polypectomy reduces the incidence and mortality of colorectal cancer. We introduced a strategy of removing all neoplastic polyps in single-session out-patient colonoscopy using cold polypectomy. We aimed to investigate the achievement of single-session complete removal rate of detected colorectal polyps in clinical practice.

Materials and methods

This retrospective study included colonoscopy-scheduled 40–79-year-old outpatients, with at least one colorectal neoplasm, between January 2015 and December 2016. Exclusion criteria were: colorectal neoplasms 21 mm or larger in size; pre-examination for colorectal surgery or endoscopic submucosal dissection; colonoscopy performed by health check program; ongoing antithrombotic treatment; inflammatory bowel disease; familial adenomatous polyposis. We defined ‘clean colon’ as the removal of all detected neoplastic polyps in a single-session colonoscopy. We evaluated clean colon rate, factors relating to clean colon failure and complications.

Results

We evaluated 2527 patients (mean age 68 years; 799 women) with 8203 colorectal polyps (7675 adenomas, 423 serrated lesions, 105 Tis and T1 cancers). In 1–4 mm polyps, cold snare polypectomy (CSP; 51.8%) and cold forceps polypectomy (CFP; 45.8%) were applied. Clean colon rates were 95.1% per patient and 97.1% per lesion. The significant factors denoting clean colon failure were inadequate bowel preparation, ≥5 lesions, and the most advanced estimated histology of adenocarcinoma, on multivariate analyses. Post-polypectomy bleeding requiring endoscopic hemostasis occurred in five patients (0.2%) who had undergone endoscopic mucosal resection (EMR) or hot snare polypectomy (HSP). Perforation occurred in one patient (0.04%) with EMR.

Conclusions

The clean colon rates were satisfactory in single-session out-patient colonoscopy using cold polypectomy.

Keywords:

• Adenoma
• colonoscopy
• polyps
• resection methods

Acknowledgments

The authors express our deepest appreciation to Dr. Yuichiro Yamaguchi, Hisatomo Ikehara, for instructive advice.

Ethical approval

This study is retrospective study. This study protocol was reviewed and approved by the institutional review board of the Shizuoka Cancer Center, approval number (J2019-95-2019-1).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, Kinichi Hotta, upon reasonable request.