European guidelines recommends the use of cold snare polypectomy (CSP) for removal of diminutive colorectal polyps (DCP). However, for DCP < 4 mm cold biopsy forceps (CBF) may be optional. We aimed to compare the efficacy of CSP with CBF for removal of DCP in routine colonoscopy.

We conducted a multicenter non-inferiority randomized controlled trial. After screening, 123 patients were prospectively included and 180 DCPs were removed by either CBF or CSP after randomization (1:1). The primary end-point was the histological complete resection rate defined by negative additional biopsies taken from the edge of the polypectomy ulcer site.

Among DCPs, 121 (67.2%) adenomas or sessile serrated lesions were considered for the analysis. Polyps were 4 [1Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, e al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths N Engl J Med 2012 ;  366 (8) : 687-696 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 2Bretthauer M, Kaminski MF, Løberg M, Zauber AG, Regula J, Kuipers EJ, e al. Population-based colonoscopy screening for colorectal cancer: a randomized clinical trial JAMA Intern Med 01 2016 ;  176 (7) : 894-902 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Lowenfels AB, Williams JL, Holub JL, Maisonneuve P, Lieberman DA. Determinants of polyp size in patients undergoing screening colonoscopy BMC Gastroenterol 2011 ;  11 : 101

Cliccare qui per andare alla sezione Riferimenti, 4Gupta N, Bansal A, Rao D, Early DS, Jonnalagadda S, Wani SB, e al. Prevalence of advanced histological features in diminutive and small colon polyps Gastrointest Endosc 2012 ;  75 (5) : 1022-1030 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti, 5Vleugels JLA, Hazewinkel Y, Fockens P, Dekker E. Natural history of diminutive and small colorectal polyps: a systematic literature review Gastrointest Endosc 2017 ;  85 (6) : 1169-1176.e1.

Cliccare qui per andare alla sezione Riferimenti] mm in size, mostly flat (55.4%) and located in the proximal colon (44.6%). The en bloc resection rate was higher in the CSP group than the CBF group (91.7% vs. 42.6%, p < 0.001). The histological complete resection rate was comparable in the two groups (93.33% vs 90.16%; p = 0.527), even for polyps < 4 mm (91.30% vs 91.30%; p = 1). All specimens were retrieved and there was no difference in terms of procedure times and adverse events. Finally, univariate analysis did not identify any potential factor associated with complete resection rate.

In this study, CSP was comparable to CBF for the removal of DCP. Therefore, CBF may be considered as an alternative technique for resection of DCP, together with CSP, ClinicalTrials.gov registry (NCT04727918)