Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2023; 29(23): 3668-3677
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3668
Hot snare polypectomy vs endoscopic mucosal resection using bipolar snare for intermediate size colorectal lesions: Propensity score matching
Nobuhisa Minakata, Tatsuro Murano, Masashi Wakabayashi, Maasa Sasabe, Takashi Watanabe, Tomohiro Mitsui, Hiroki Yamashita, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tomohiro Kadota, Kensuke Shinmura, Hiroaki Ikematsu, Tomonori Yano
Nobuhisa Minakata, Tatsuro Murano, Maasa Sasabe, Takashi Watanabe, Tomohiro Mitsui, Hiroki Yamashita, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tomohiro Kadota, Kensuke Shinmura, Hiroaki Ikematsu, Tomonori Yano, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa 2778577, Chiba, Japan
Masashi Wakabayashi, Department of Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Kashiwa 2778577, Chiba, Japan
Author contributions: Minakata N, Murano T and Ikematsu H contributed to conceptualization; Minakata N and Murano T contributed to methodology; Minakata N and Wakabayashi M contributed to statistical analysis; Minakata N and Murano T contributed to writing - original draft preparation; Wakabayashi M, Sasabe M, Watanabe T, Mitsui T, Yamashita H, Inaba A, Sunakawa H, Nakajo K, Kadota T, Shinmura K, Ikematsu H, and Yano T contributed to writing - review and editing.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of our hospital, No. 2017-434.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting this study’s findings are available from the corresponding author, Murano T, upon reasonable request at tatmuran@east.ncc.go.jp.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tatsuro Murano, MD, PhD, Doctor, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa 2778577, Chiba, Japan. tatmuran@east.ncc.go.jp
Received: March 2, 2023
Peer-review started: March 2, 2023
First decision: April 8, 2023
Revised: April 21, 2023
Accepted: May 23, 2023
Article in press: May 23, 2023
Published online: June 21, 2023
Abstract
BACKGROUND

Endoscopic resection (ER) with bipolar snare, in which the electric current only passes through the tissue between the device’s two electrodes, is a prominent method used to prevent perforation due to electricity potentially. ER using bipolar snare with or without submucosal injection enabled safe resection of colorectal lesions measuring 10–15 mm in an ex vivo porcine model. ER with bipolar snare is expected to have good treatment outcomes in 10–15 mm colorectal lesions, with high safety even without submucosal injection. However, no clinical reports have compared treatment outcomes with and without submucosal injection.

AIM

To compare the treatment outcomes of bipolar polypectomy with hot snare polypectomy (HSP) to those with endoscopic mucosal resection (EMR).

METHODS

In this single-centre retrospective study, we enrolled 10–15 mm nonpedunculated colorectal lesions (565 Lesions in 463 patients) diagnosed as type 2A based on the Japan Narrow-band Imaging Expert Team classification, resected by either HSP or EMR between January 2018 and June 2021 at the National Cancer Center Hospital East. Lesions were divided into HSP and EMR groups, and propensity score matching was performed. In the matched cohort, en bloc and R0 resection rates and adverse events were compared between the two groups.

RESULTS

Of the 565 lesions in 463 patients, 117 lesions each in the HSP and EMR groups were selected after propensity score matching. In the original cohort, there was a significant difference in antithrombotic drug use (P < 0.05), lesion size (P < 0.01), location (P < 0.01), and macroscopic type (P < 0.05) between the HSP and EMR groups. In the matched cohort, the en bloc resection rates were comparable between both groups [93.2% (109/117) vs 92.3% (108/117), P = 0.81], and there was no significant difference in the R0 resection rate [77.8% (91/117) vs 80.3% (94/117), P = 0.64]. The incidence of delayed bleeding was similar in both groups [1.7% (2/117)]. Perforation occurred in the EMR group [0.9% (1/117)] but not in the HSP group.

CONCLUSION

Using bipolar snare, ER of nonpedunculated 10–15 mm colorectal lesions may be performed safely and effectively, even without submucosal injection.

Keywords: Adenoma, Cohort studies, Colonoscopy, Colorectal cancer, Endoscopic mucosal resection, Treatment outcome

Core Tip: This study is the first to compare treatment outcomes between hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR) using a bipolar snare for nonpedunculated colorectal lesions measuring 10–15 mm. First, there was no significant difference in en bloc and R0 resection rates between the HSP and EMR groups. Second, the incidence of adverse events was similar in both groups, but perforation occurred only in the EMR group. These results suggest that comparable treatment efficiency and safety may be obtained even without submucosal injection when resecting nonpedunculated colorectal lesions measuring 10–15 mm using a bipolar snare.