Management and risk factors for incomplete resection associated with jumbo forceps polypectomy for diminutive colorectal polyps: a single-institution retrospective study
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Cold forceps polypectomy is simple and widely used in clinical practice. However, there are concerns about the risk of incomplete resection using this technique. In recent years, it has been reported that polypectomy with jumbo forceps (JF) is an effective treatment modality for diminutive polyps (DPs) because JF are able to remove large tissue samples with the combined advantage of a higher complete histological resection rate for DPs than standard forceps. To our knowledge, no studies have evaluated the risk factors for incomplete resection when polypectomy with JF is performed for DPs.
From among 1129 DPs resected using JF at Hiroshima City Asa Citizens Hospital between November 2015 and December 2016, we retrospectively evaluated the clinical outcomes of 999 tumors with known histopathology and investigated the relationship between incomplete resection and clinicopathological factors.
Most lesions [985 (87%)] were low-grade dysplasia and 14 (1%) were high-grade dysplasia. The en bloc resection rate was 92% (918/999) and the histological en bloc resection rate was 78% (777/999). Multivariate analysis showed that the significant independent predictors of incomplete resection were tumor size ≥ 4 mm [odds ratio (OR) 3.8; 95% confidence interval (CI) 2.65–5.37; p < 0.01], non-tangential direction of forceps in relation to the tumor (OR 1.73; 95% CI 1.21–2.45; p < 0.01), and lack of muscularis mucosae in the pathological specimen (OR 15.7; 95% CI 9.16–27.7; p < 0.01).
This study identified significant independent predictors of incomplete resection of DPs which may be helpful when planning polypectomy with JF.
KeywordsCold forceps polypectomy Diminutive colorectal polyps Risk factors for incomplete resection Tangential direction of forceps Muscularis mucosae
NA and SN conceived and designed the study, performed the statistical analysis, interpreted the data, and drafted the manuscript. NA, SN, KS, YO, HT, YS, TA, AF, and SM acquired the data. MK analyzed and interpreted the histopathological data. All authors critically revised the article for important intellectual content and approved the article for publication.
Compliance with ethical standards
Naoki Asayama, Shinji Nagata, Kenjiro Shigita, Yutaro Ogawa, Hirosato Tamari, Taiki Aoyama, Akira Fukumoto, Shinichi Mukai, and Mayumi Kaneko have no conflicts of interest or financial ties to disclose.
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