Cold snare polypectomy is underutilized despite recommendation

Just over half of endoscopists use cold snare polypectomy to remove small polyps smaller than 1 cm. Recommendations from the U.S. Multi-Social Task Force Its use in small lesions shows new research presented this week at the American College of Gastroenterology’s annual meeting in Vancouver.

Polypectomy is an important part colorectal cancer However, he noted that the endoscopist’s choice of polypectomy is a key component of quality, and the characteristics of polypectomy in clinical practice vary widely. Seth D. Crockett, MDOregon Health & Science University, Portland, in a conference presentation.

Cold snare polypectomy is associated with high incomplete resection rates, inadequate histopathological specimens, and/or complication rates. Crockett said it was previously unknown whether endoscopists were complying with the recommendations.

The average cold snare polypectomy rate (CSPR) by endoscopists was 51.2%, which was “lower than expected based on current guideline recommendations,” Crockett said.

High rates of cold snare polypectomy were more common among specialists trained in gastroenterology and more common among physicians practicing in the Midwest (69%). This compared to 40% of practitioners in the Northeast, which had the lowest implementation rate. Colonoscopy volume, adenoma detection rate (ADR), serrated polyp detection rate (SDR), and cecal intubation rate (CIR) were all associated with higher CSPR.

Compared with endoscopists with an adenoma detection rate (ADR) of <25%, endoscopists with an adenoma detection rate (ADR) >35% had a CSPR >30% higher (58% vs. 27, respectively). %; P < .0001). Crockett said if polyps are missed, the problem of interval cancer could be exacerbated by low utilization of endoscopists with low ADR. Endoscopist detection rate of serrated polyps ≥7%, cecal intubation rate ≥95%, and mean extraction time >9 minutes were significantly associated with higher CSPR. (P < .0001 in all).

Jonathan A. Layton, M.D., of the Mayo Clinic in Scottsdale, Ariz., said in an interview that the study’s results show a link between increased use of cold snares and improvements in quality metrics such as adenoma detection rates and cecal intubation rates. This suggests that there is a correlation.

“I agree with the authors that much of the focus on colonoscopy quality has been on polyp detection, with little focus on polyp removal quality, which is difficult to measure.” he said. “Their results suggest that cold snare polypectomy, which removes small polyps, is currently underutilized, but, like other polypectomy procedures, can remove dysplastic tissue using appropriate techniques. It is important to remove all of them.”

This result was supported by the large sample size and high fidelity of polyp size, polypectomy tools, and quality measurements. However, further research is needed to determine the impact of polypectomy on the efficacy and safety outcomes of colonoscopy. In terms of limitations, small polyps have a relatively low risk of recurrence, and the association between endoscopists’ polypectomy practices and polyp recurrence, interval cancer, and adverse events has not been investigated, Crockett said. Stated.

This research was supported by a grant from ACG. Crockett disclosed relationships with Carelon, Exact Sciences, Freenome, and Guardant.

This story was originally MDedge.compart of the Medscape Professional Network.