Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps
Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps
复制标题
小结直肠息肉的冷与热圈套器息肉切除术
作者：
Li‐Chun Chang;Chi;Chi;Cheng;Peng;C. Shun;Wen;Yen;Chieh;Tien;C. Tu;Mei;C. Chou;Ching‐Tai Lee;Po;Ming;Han
背景
尽管冷圈套器息肉切除术（CSP）被认为可有效降低息肉切除术后迟发性出血风险，但仍缺乏支持其在普通人群中安全性的直接证据。
目标
旨在阐明与热圈套器息肉切除术 (HSP) 相比，在一般人群中 CSP 是否会降低息肉切除术后迟发性出血的风险。
设计
多中心随机对照研究。 （ClinicalTrials.gov：NCT03373136）。
设置
2018 年 7 月至 2020 年 7 月期间，台湾有 6 个站点。
参加者
年龄在 40 岁或以上、息肉直径为 4 至 10 毫米的参与者。
干预
CSP 或 HSP 可去除 4 至 10 毫米的息肉。
测量值
主要结局是息肉切除术后 14 天内的延迟出血率。严重出血定义为血红蛋白浓度降低20 g/L或更多，需要输血或止血。次要结局包括平均息肉切除时间、成功的组织取出、整块切除、完整的组织学切除和紧急服务就诊。
结果
共有 4270 名参与者被随机分配（2137 名参与者被分配到 CSP，2133 名参与者被分配到 HSP）。 CSP 组中有 8 名患者 (0.4%) 和 HSP 组有 31 名患者 (1.5%) 出现延迟出血（风险差异，-1.1% [95% CI，-1.7% 至 -0.5%]）。 CSP 组的严重迟发性出血也较低（1 例 [0.05%] 与 8 例 [0.4%] 事件；风险差异，-0.3% [CI，-0.6% 至 -0.05%]）。 CSP 组的平均息肉切除时间（119.0 秒与 162.9 秒；平均值差异为 -44.0 秒 [CI，-53.1 至 -34.9 秒]）较短，但成功的组织取回、整块切除和完全组织学切除没有差异。 CSP 组的紧急服务就诊次数少于 HSP 组（4 次 [0.2%] 对比 13 次 [0.6%]；风险差异，-0.4% [CI，-0.8% 至 -0.04%]）。
局限性
开放标签、单盲试验。
结论
与 HSP 相比，小结直肠息肉的 CSP 显着降低了延迟性息肉切除术后出血的风险，包括严重事件。
主要资金来源
波士顿科学公司。
BACKGROUND
Although cold snare polypectomy (CSP) is considered effective in reducing delayed postpolypectomy bleeding risk, direct evidence supporting its safety in the general population remains lacking.
OBJECTIVE
To clarify whether CSP would reduce delayed bleeding risk after polypectomy compared with hot snare polypectomy (HSP) in the general population.
DESIGN
Multicenter randomized controlled study. (ClinicalTrials.gov: NCT03373136).
SETTING
6 sites in Taiwan, July 2018 through July 2020.
PARTICIPANTS
Participants aged 40 years or older with polyps of 4 to 10 mm.
INTERVENTION
CSP or HSP to remove polyps of 4 to 10 mm.
MEASUREMENTS
The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Severe bleeding was defined as a decrease in hemoglobin concentration of 20 g/L or more, requiring transfusion or hemostasis. Secondary outcomes included mean polypectomy time, successful tissue retrieval, en bloc resection, complete histologic resection, and emergency service visits.
RESULTS
A total of 4270 participants were randomly assigned (2137 to CSP and 2133 to HSP). Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (risk difference, -1.1% [95% CI, -1.7% to -0.5%]). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, -0.3% [CI, -0.6% to -0.05%]). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, -44.0 seconds [CI, -53.1 to -34.9 seconds]) was shorter in the CSP group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ. The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, -0.4% [CI, -0.8% to -0.04%]).
LIMITATION
An open-label, single-blind trial.
CONCLUSION
Compared with HSP, CSP for small colorectal polyps significantly reduces the risk for delayed postpolypectomy bleeding, including severe events.
PRIMARY FUNDING SOURCE
Boston Scientific Corporation.
DOI：
10.1056/nejmoa1100370
发表时间：
2012-02-23
期刊：
The New England journal of medicine
影响因子：
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作者：
Zauber AG;Winawer SJ;O'Brien MJ;Lansdorp-Vogelaar I;van Ballegooijen M;Hankey BF;Shi W;Bond JH;Schapiro M;Panish JF;Stewart ET;Waye JD
通讯作者：
Waye JD