Thématique :
- Endoscopie/Imagerie
Originalité :
Solidité :
Très solide
Doit faire évoluer notre pratique :
Nom du veilleur :
Docteur Patrice PIENKOWSKI
Coup de coeur :
Gastrointestinal Endoscopy
  2015 Oct;82(4):686-92  
  doi: 10.1016/j.gie.2015.02.012  
  Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps  
  Horiuchi A, Hosoi K, Kajiyama M, Tanaka N, Sano K, Graham DY  

Both cold-only snare and hot polypectomy snare are used for the removal of small colorectal polyps.

To compare the outcome of cold snare polypectomy of small colorectal polyps with a snare exclusively designed as a cold snare versus cold snare polypectomy by using a traditional polypectomy snare.

Prospective, randomized, controlled study.

Municipal hospital in japan.

Patients with colorectal polyps 10 mm or smaller in diameter were randomized to dedicated cold snare (dedicated cold snare group) or traditional cold snare (traditional cold snare group). The primary outcome measure was complete resection rates by cold snaring based on pathological examination. Secondary outcomes included bleeding within 2 weeks after polypectomy and identification of submucosal arteries and injured arteries in the resected specimens.

Seventy-six patients having 210 eligible polyps were randomized: dedicated cold snare group, n = 37 (98 polyps) and traditional cold snare group, n = 39 (112 polyps). Patient demographic characteristics including the number, size, and shape of the polyps removed were similar in the 2 groups. The complete resection rate was significantly greater with the dedicated cold than with the traditional cold snare (91% [89/98] vs 79% [88/112], p = .015), with a marked difference with 8- to 10-mm polyps, both flat and pedunculated. Immediate bleeding and hematochezia rates were similar (19% vs 21%, p = .86; 5.4% vs 7.7%, p = .69). No delayed bleeding occurred. Histology demonstrated a similar prevalence of arteries and injured arteries in the submucosa (33% [32/96] vs 30% [31/104], p = .59; 3.1% [3/96] vs 6.7% [7/104], p = .24).

Small sample size, single-center study.

Polypectomy by using a dedicated cold snare resulted in complete polyp removal more often than did cold snaring with a traditional snare, especially polyps 8 to 10 mm in diameter, whether flat or pedunculated.

Clinical trial registration number:

Copyright © 2015 american society for gastrointestinal endoscopy. Published by elsevier inc. All rights reserved.

Question posée
Quel est le meilleur outil pour les polypectomies à l’anse froide ?
Question posée
Etude comparative randomisée sur 76 patients avec 210 polypes éligibles. Tolérance identique mais complétude de la résection meilleure avec une anse dédiée qu’avec une anse polyvalente (91 vs 79%) avec une différence plus marquée pour les polypes de 8-10mm. Les taux de saignement immédiat étaient identiques ; il n’y a pas eu de saignement à distance.

L’anse froide est proposée pour la résection de polypes de taille intermédiaire ; si ce choix est retenu, il vaut mieux utiliser un matériel spécifiquement dédié plutôt qu’une anse polyvalente.