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Su1655 A Prospective Comparison of Cold Snare Polypectomy Using Traditional or Dedicated Cold Snares for the Resection of Small Sessile Colorectal Polyps
Abstracts
Su1655 A Prospective Comparison of Cold Snare Polypectomy Using Traditional or Dedicated Cold Snares for the Resection of Small Sessile Colorectal Polyps Jeremy Dwyer*1, Jonathan (Yong) C. Tan1, Paul Urquhart1, Robyn Secomb1, Catherine Bunn1, John Reynolds2, Richard La Nauze1, William Kemp1, Stuart K. Roberts1, Gregor J. Brown1 1 Gastroenterology, Alfred hospital, Melbourne, Victoria, Australia; 2 Biostatistics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
Table 1. Key comparisons between conventional adenomas (CoAs), traditional serrated adenomas (TSAs) and serrated tubulovillous adenomas (sTVAs).
Background and Aims: Cold snare polypectomy is a common method for removing small colorectal polyps, which forms the basis of preventing colorectal cancer. The effectiveness of polypectomy is dependent on the completeness of endoscopic resection, which may be improved by using dedicated cold snares. Despite widespread use in clinical practice, the evidence base for cold snare polypectomy remains limited. The aim of this study was to prospectively assess the completeness of resection and safety of cold snare polypectomy, using either traditional or dedicated cold snares. Methods: This was a prospective, non-randomized study performed at a single tertiary hospital. Adult patients undergoing colonoscopy for routine indications with at least one sessile colorectal polyp (size 10 mm) removed by cold snare were included. Patients with pedunculated polyps or who underwent hot snare polypectomy were excluded. Procedures were performed by Gastroenterology consultants or supervised trainees using variable-stiffness colonoscopes (Olympus 180 or 190-series, Tokyo Japan). In the first phase of the study, all patients had polyps removed by traditional snare without diathermy (SnareMasterÒ, loop size 10 mm, 0.40 or 0.47 mm wire diameter, Olympus, Tokyo Japan). In the second phase, all patients had polyps removed by dedicated cold snare (ExactoÒ, loop size 9 mm, 0.30 mm wire diameter, US endoscopy, Ohio USA). The primary outcome of completeness of endoscopic resection was assessed by histological examination of quadrantic biopsies taken from the polypectomy site margin. Secondary outcomes of immediate or late complications (within 2 weeks post-colonoscopy) were recorded. To allow for clustering of polyps within individuals, the method of Generalized Estimating Equations was used to estimate rates of complete resection and their 95% confidence intervals. Results: One hundred and eighty-one patients with 299 eligible polyps (nZ93 (173 polyps) traditional snare group, nZ88 (126 polyps) dedicated cold snare group) were included. Patient demographics and procedure indications were similar between cold snare groups, however more patients in the traditional snare group were taking antiplatelet or anticoagulant therapy (23% vs. 7%, PZ0.01). Mean polyp size was 6 mm in both groups (PZ0.25). The complete polyp resection rate was 165/173 (95.2%; 95%CI 90.5-97.6%) in the traditional snare group and 124/126 (98.4%; 95%CI 93.7-99.6%) in the dedicated cold snare group (PZ0.16). There was no difference in the rate of immediate post-polypectomy bleeding (nZ1 (1%) traditional snare group, nZ0 (0%) dedicated cold snare group); and there were no delayed post-polypectomy hemorrhages or perforations. Conclusion: Cold snare polypectomy is effective and safe for removing small colorectal polyps with either traditional or dedicated cold snares.
Su1656 Adenoma Detection Rate in Screening Compared to NonScreening Colonoscopies: A Cross-Sectional Study Sherif Elhanafi*, David C. Metz, Gregory G. Ginsberg, Shivan J. Mehta, Nuzhat A. Ahmad Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Table 2. Key comparisons between traditional serrated adenomas (TSAs) and serrated tubulovillous adenomas (sTVAs).
www.giejournal.org
Background: Adenoma detection rate (ADR) is an established quality indicator for screening colonoscopy. The ADR for non-screening colonoscopies is not well studied. The aim of this study is to assess and compare the ADR for screening colonoscopies performed for average-risk individuals versus colonoscopies for all other indications. Method: This is a retrospective, cross-sectional study on colonoscopies performed by 26 endoscopists at a tertiary care center from August 2015 to November 2015. The study cohort was divided into two groups; colonoscopies for average-risk screening versus colonoscopies for all indications other than screening. Colonoscopy procedures and pathology records were reviewed for each patient. ADR (number of colonoscopies with at least 1 adenoma divided by the number of colonoscopies) was calculated for each group separately. The ANOVA and Chisquare tests were performed to compare variables between the two groups. Results: A total of 2,078 colonoscopies were included, of whom 618 (30%) were performed for average-risk screening, while 1460 (70%) were performed for non-screening indications. The overall ADR for the screening group was 41.4% while in the nonscreening group, it was 40.9% (r Z 0.71, p Z 0.73). 1159/2078 (55.7%) colonoscopies were performed on females with an overall ADR of 33.6%, while 919/2078 (44.3%) were performed in males with an overall ADR of 50.4% (p <0.001). There was no significant difference in the ADR for females in the screening group compared with non-screening group (32% vs 34.3%, p Z 0.4), while the ADR was higher in males for screening compared with non-screening (54% vs 48.9%, p <0.001) Conclusion: In this retrospective, cross-sectional study, there is no difference in the overall ADR for colonoscopies for average-risk screening and colonoscopies for indications other than screening. An overall ADR for non-screening
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB381
Su1655 A Prospective Comparison of Cold Snare Polypectomy Using Traditional or Dedicated Cold Snares for the Resection of Small Sessile Colorectal Polyps Jeremy Dwyer*1, Jonathan (Yong) C. Tan1, Paul Urquhart1, Robyn Secomb1, Catherine Bunn1, John Reynolds2, Richard La Nauze1, William Kemp1, Stuart K. Roberts1, Gregor J. Brown1 1 Gastroenterology, Alfred hospital, Melbourne, Victoria, Australia; 2 Biostatistics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
Table 1. Key comparisons between conventional adenomas (CoAs), traditional serrated adenomas (TSAs) and serrated tubulovillous adenomas (sTVAs).
Background and Aims: Cold snare polypectomy is a common method for removing small colorectal polyps, which forms the basis of preventing colorectal cancer. The effectiveness of polypectomy is dependent on the completeness of endoscopic resection, which may be improved by using dedicated cold snares. Despite widespread use in clinical practice, the evidence base for cold snare polypectomy remains limited. The aim of this study was to prospectively assess the completeness of resection and safety of cold snare polypectomy, using either traditional or dedicated cold snares. Methods: This was a prospective, non-randomized study performed at a single tertiary hospital. Adult patients undergoing colonoscopy for routine indications with at least one sessile colorectal polyp (size 10 mm) removed by cold snare were included. Patients with pedunculated polyps or who underwent hot snare polypectomy were excluded. Procedures were performed by Gastroenterology consultants or supervised trainees using variable-stiffness colonoscopes (Olympus 180 or 190-series, Tokyo Japan). In the first phase of the study, all patients had polyps removed by traditional snare without diathermy (SnareMasterÒ, loop size 10 mm, 0.40 or 0.47 mm wire diameter, Olympus, Tokyo Japan). In the second phase, all patients had polyps removed by dedicated cold snare (ExactoÒ, loop size 9 mm, 0.30 mm wire diameter, US endoscopy, Ohio USA). The primary outcome of completeness of endoscopic resection was assessed by histological examination of quadrantic biopsies taken from the polypectomy site margin. Secondary outcomes of immediate or late complications (within 2 weeks post-colonoscopy) were recorded. To allow for clustering of polyps within individuals, the method of Generalized Estimating Equations was used to estimate rates of complete resection and their 95% confidence intervals. Results: One hundred and eighty-one patients with 299 eligible polyps (nZ93 (173 polyps) traditional snare group, nZ88 (126 polyps) dedicated cold snare group) were included. Patient demographics and procedure indications were similar between cold snare groups, however more patients in the traditional snare group were taking antiplatelet or anticoagulant therapy (23% vs. 7%, PZ0.01). Mean polyp size was 6 mm in both groups (PZ0.25). The complete polyp resection rate was 165/173 (95.2%; 95%CI 90.5-97.6%) in the traditional snare group and 124/126 (98.4%; 95%CI 93.7-99.6%) in the dedicated cold snare group (PZ0.16). There was no difference in the rate of immediate post-polypectomy bleeding (nZ1 (1%) traditional snare group, nZ0 (0%) dedicated cold snare group); and there were no delayed post-polypectomy hemorrhages or perforations. Conclusion: Cold snare polypectomy is effective and safe for removing small colorectal polyps with either traditional or dedicated cold snares.
Su1656 Adenoma Detection Rate in Screening Compared to NonScreening Colonoscopies: A Cross-Sectional Study Sherif Elhanafi*, David C. Metz, Gregory G. Ginsberg, Shivan J. Mehta, Nuzhat A. Ahmad Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Table 2. Key comparisons between traditional serrated adenomas (TSAs) and serrated tubulovillous adenomas (sTVAs).
www.giejournal.org
Background: Adenoma detection rate (ADR) is an established quality indicator for screening colonoscopy. The ADR for non-screening colonoscopies is not well studied. The aim of this study is to assess and compare the ADR for screening colonoscopies performed for average-risk individuals versus colonoscopies for all other indications. Method: This is a retrospective, cross-sectional study on colonoscopies performed by 26 endoscopists at a tertiary care center from August 2015 to November 2015. The study cohort was divided into two groups; colonoscopies for average-risk screening versus colonoscopies for all indications other than screening. Colonoscopy procedures and pathology records were reviewed for each patient. ADR (number of colonoscopies with at least 1 adenoma divided by the number of colonoscopies) was calculated for each group separately. The ANOVA and Chisquare tests were performed to compare variables between the two groups. Results: A total of 2,078 colonoscopies were included, of whom 618 (30%) were performed for average-risk screening, while 1460 (70%) were performed for non-screening indications. The overall ADR for the screening group was 41.4% while in the nonscreening group, it was 40.9% (r Z 0.71, p Z 0.73). 1159/2078 (55.7%) colonoscopies were performed on females with an overall ADR of 33.6%, while 919/2078 (44.3%) were performed in males with an overall ADR of 50.4% (p <0.001). There was no significant difference in the ADR for females in the screening group compared with non-screening group (32% vs 34.3%, p Z 0.4), while the ADR was higher in males for screening compared with non-screening (54% vs 48.9%, p <0.001) Conclusion: In this retrospective, cross-sectional study, there is no difference in the overall ADR for colonoscopies for average-risk screening and colonoscopies for indications other than screening. An overall ADR for non-screening
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB381