NOVEL METHOD TO ASSESS COLD SNARE POLYPECTOMY QUALITY FOR 1-10 MM COLORECTAL POLYPS - MEASURING THE MINIMUM EXTENT OF A HEALTHY RESECTION MARGIN

作者：Heiko Pohl, Daniel von Renteln, Andres Aguilera-Fish, J M Anderson · 发表于：Endoscopy · 年份：2020 · DOI：10.1055/s-0040-1704203 · 被引用次数：3 · 研究领域：Medical and Biological Sciences

Aims Measuring quality of polypectomy in clinical practice remains a challenge. We examined the extent of a normal healthy tissue margin around neoplastic tissue of the resected polyp specimen as a potential quality measure for polypectomy. Methods Prospective single center study in patients who underwent a colonoscopy with non-cautery (cold) polyp resection. All non-fragmented polyps were included. Snares were rotated monthly (one snare type each month). The healthy margin was defined as the difference between specimen and neoplasia size (serrated or adenomatous; measured by the pathologist) divided by two. We assessed the healthy margin across endoscopists, by type of snare, and by polyp characteristics. Results 561 patients with 1724 polyps were included. The mean size as estimated by the endoscopist was 4.0 mm (median 4 mm). This estimate was approximately 50% greater than the measured neoplasia size of 2.6 mm (median 2.0 mm). The healthy margin varied across endoscopist from 0.8 to 1.4 mm (p< 0.001), with an almost 2-fold variation of a minimum margin of ≥1 mm (29% to 57%) across endoscopists (p< 0.001). Attending-gastroenterologists resected polyps with a greater margin than trainees (p< 0.001). Dedicated cold snares achieved a larger resection margin than standard snares (1.4 vs 1.0 mm, p< 0.001), and a greater proportion of margins ≥1mm (56% vs 39%, p< 0.001). There was no difference in the margin by polyp size, proximal location, or histology. Conclusions The study e...