Results of the COLDWATER randomized controlled trial: enhanced performance of underwater cold snare polypectomy for colorectal polyps 5-10 mm, independent of endoscopist experience.

Autor:	Zachou M; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica).; Department of Gastroenterology, 'Sismanogleio' General Hospital, Athens (Maria Zachou, Nikolaos Nikiteas, Stilianos Kykalos)., Nifora M; Department of Pathology, 'Sismanogleio' General Hospital, Athens (Martha Nifora, Christina Zoumpouli)., Androutsakos T; Department of Pathophysiology, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Theodoros Androutsakos, Stavros Sougioultzis)., Katsaras G; Pediatric Department, General Hospital of Pella-Hospital Unit of Edessa (Georgios Katsaras)., Varytimiadis K; Department of Gastroenterology, 'Evangelismos' General Hospital, Athens (Konstantinos Varytimiadis)., Zoumpouli C; Department of Pathology, 'Sismanogleio' General Hospital, Athens (Martha Nifora, Christina Zoumpouli)., Karantanos P; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica)., Lalla E; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica)., Mpetsios G; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica)., Panoutsakou M; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica)., Stoica R; Second Department of Propaedeutic Surgery, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Maria Zachou, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica)., Thermou D; Department of Surgery, 'Hippocratio' General Hospital, Athens (Dionisia Thermou)., Mavrogenis G; Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens (Georgios Mavrogenis)., Ntikoudi E; Intensive Care Unit, Sotiria Thoracic Diseases Hospital, Athens (Evangelia Ntikoudi)., Nikiteas N; Department of Gastroenterology, 'Sismanogleio' General Hospital, Athens (Maria Zachou, Nikolaos Nikiteas, Stilianos Kykalos)., Sougioultzis S; Department of Pathophysiology, 'Laikon' General Hospital, Medical School, National and Kapodistrian University of Athens (Theodoros Androutsakos, Stavros Sougioultzis)., Kalaitzakis E; Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion (Evangelos Kalaitzakis); Greece., Kykalos S; Department of Gastroenterology, 'Sismanogleio' General Hospital, Athens (Maria Zachou, Nikolaos Nikiteas, Stilianos Kykalos).
Jazyk:	angličtina
Zdroj:	Annals of gastroenterology [Ann Gastroenterol] 2024 Jul-Aug; Vol. 37 (4), pp. 466-475. Date of Electronic Publication: 2024 Jun 14.
DOI:	10.20524/aog.2024.0889
Abstrakt:	Background: The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety. Methods: This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for non-pedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the muscularis mucosa resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, en bloc resection rate, adverse events, and recurrence rate. Results: The COLDWATER study found higher muscularis mucosa resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and en bloc resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than non-experts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels. Conclusions: UCSP achieves a more extensive excision of the muscularis mucosa compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher en bloc resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection. Competing Interests: Conflict of Interest: None (Copyright: © 2024 Hellenic Society of Gastroenterology.)
Databáze:	MEDLINE
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