Cold Versus Hot Snare Endoscopic Resection of Large Nonpedunculated Colorectal Polyps: Randomized Controlled German CHRONICLE Trial

被引：22

作者：

Steinbrueck, Ingo ^{[1
]}

Ebigbo, Alanna ^{[2
]}

Kuellmer, Armin ^{[3
]}

Schmidt, Arthur ^{[3
,4
]}

Kouladouros, Konstantinos ^{[5
]}

Brand, Markus ^{[6
]}

Koenen, Teresa ^{[7
]}

Rempel, Viktor ^{[8
]}

Wannhoff, Andreas ^{[9
]}

Faiss, Siegbert ^{[10
]}

Pech, Oliver ^{[11
,12
]}

Moeschler, Oliver ^{[13
]}

Dumoulin, Franz Ludwig ^{[14
]}

Kirstein, Martha M. ^{[15
]}

von Hahn, Thomas ^{[16
]}

Allescher, Hans-Dieter ^{[17
]}

Goelder, Stefan K. ^{[18
]}

Goetz, Martin ^{[19
]}

Hollerbach, Stephan ^{[20
]}

Lewerenz, Bjoern ^{[21
]}

Meining, Alexander ^{[6
]}

Messmann, Helmut ^{[2
]}

Roesch, Thomas ^{[22
]}

Allgaier, Hans-Peter ^{[1
]}

机构：

[1] Univ Freiburg, Acad Teaching Hosp, Dept Med & Gastroenterol, Evangelisches Diakoniekrankenhaus Freiburg, Wirthstr 11, D- 79110 Freiburg, Germany

[2] Univ Hosp Augsburg, Dept Gastroenterol, Augsburg, Germany

[3] Univ Freiburg, Fac Med, Med Ctr, Dept Med 2, Freiburg, Germany

[4] Univ Tubingen, Acad Teaching Hosp, Robert Bosch Krankenhaus, Dept Gastroenterol Hepatol & Endocrinol, Stuttgart, Germany

[5] Heidelberg Univ, Mannheim Univ Hosp, Cent Interdisciplinary Endoscopy Dept, Mannheim, Germany

[6] Univ Hosp Wurzburg, Dept Med 2, Wurzburg, Germany

[7] Rheinisch Westfalische TH Aachen, Acad Teaching Hosp, Dept Gastroenterol, Rhein Maas Klinikum Wurselen, Wurselen, Germany

[8] Ruhr Univ Bochum, St Anna Hosp Herne, Dept Gastroenterol, Acad Teaching Hosp, Bochum, Germany

[9] Heidelberg Univ, Acad Teaching Hosp, Klinikum Ludwigsburg, Dept Gastroenterol,Regionale Kliniken Holding & Se, Ludwigsburg, Germany

[10] Univ Berlin, Acad Teaching Hosp, Dept Gastroenterol, Sana Klinikum Lichtenberg, Berlin, Germany

[11] Univ Regensburg, Acad Teaching Hosp, Dept Gastroenterol & Endoscopy, Krankenhaus Barmherzige Bruder Regensburg, Regensburg, Germany

[12] Tech Univ Munich, Regensburg, Germany

[13] Univ Hannover, Acad Teaching Hosp, Dept Endoscopy & Ultrasound, Marienhosp Osnabruck, Osnabruck, Germany

[14] Univ Bonn, Acad Teaching Hosp, Dept Med & Gastroenterol, Gemeinschaftskrankenhaus Bonn, Bonn, Germany

[15] Univ Hosp Lubeck, Univ Hosp Schleswig Holstein, Dept Med 1, Lubeck, Germany

[16] Univ Hamburg, Acad Teaching Hosp, Dept Gastroenterol Hepatol & Endoscopy, Asklepios Klin Barmbek, Hamburg, Germany

[17] Univ Munich, Acad Teaching Hosp, Dept Gastroenterol, Klinikum Garmisch Patenkirchen, Garmisch Patenkirchen, Germany

[18] Univ Ulm, Acad Teaching Hosp, Dept Internal Med 1, Ostalb Klinikum Aalen, Aalen, Germany

[19] Univ Tubingen, Acad Teaching Hosp, Dept Internal Med, Klin Boblingen, Boblingen, Germany

[20] Univ Hannover, Acad Teaching Hosp, Allgemeines Krankenhaus Celle, Dept Gastroenterol, Celle, Germany

[21] Univ Munich, Acad Teaching Hosp, Dept Gastroenterol & Hepatol, Klinikum Traunstein, Traunstein, Germany

[22] Univ Hosp Eppendorf, Dept Interdisciplinary Endoscopy, Hamburg, Germany

来源：

GASTROENTEROLOGY | 2024年 / 167卷 / 04期

关键词：

Colonoscopy; Endoscopic Resection; Endoscopic Mucosal Resection; Cold Snare; Hot Snare; Adverse Event; Complication; Residual Adenoma; MUCOSAL RESECTION; LARGE SESSILE; RISK-FACTORS; EUROPEAN-SOCIETY; LOCAL RECURRENCE; COLONIC POLYPS; POLYPECTOMY; EMR; MM; METAANALYSIS;

D O I：

10.1053/j.gastro.2024.05.013

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND & AIMS: Endoscopic mucosal resection (EMR) is standard therapy for nonpedunculated colorectal polyps >= 20 mm. It has been suggested recently that polyp resection without current (cold resection) may be superior to the standard technique using cutting/coagulation current (hot resection) by reducing adverse events (AEs), but evidence from a randomized trial is missing. METHODS: In this randomized controlled multicentric trial involving 19 centers, nonpedunculated colorectal polyps >= 20 mm were randomly assigned to cold or hot EMR. The primary outcome was major AE (eg, perforation or postendoscopic bleeding). Among secondary outcomes, major AE subcategories, postpolypectomy syndrome, and residual adenoma were most relevant. RESULTS: Between 2021 and 2023, there were 396 polyps in 363 patients (48.2% were female) enrolled for the intention-to- treat analysis. Major AEs occurred in 1.0% of the cold group and in 7.9% of the hot group (P P = .001; odds ratio [OR], 0.12; 95% CI, 0.03-0.54). - 0.54). Rates for perforation and postendoscopic bleeding were significantly lower in the cold group, with 0% vs 3.9% (P P = .007) and 1.0% vs 4.4% (P P = .040). Postpolypectomy syndrome occurred with similar frequency (3.1% vs 4.4%; P = .490). After cold resection, residual adenoma was found more frequently, with 23.7% vs 13.8% (P = .020; OR, 1.94; 95% CI, 1.12-3.38). In multivariable analysis, lesion diameter of >= 4 cm was an independent predictor both for major AEs (OR, 3.37) and residual adenoma (OR, 2.47) and high-grade dysplasia/cancer for residual adenoma (OR, 2.92). CONCLUSIONS: Cold resection of large, nonpedunculated colorectal polyps appears to be considerably safer than hot EMR; however, at the cost of a higher residual adenoma rate. Further studies have to confirm to what extent polyp size and histology can determine an individualized approach. German Clinical Trials Registry (Deutsches Register Klinischer Studien), Number DRKS00025170.

引用

页码：764 / 777

页数：14

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