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Cold polypectomy

1) 2)

1) 2)

1 - 5mm 6 - 9mm 1 c m Cold polypectomy jumbo Cold forceps polypectomy Cold snare polypectomy burning effect NBI

Key wordsCold polypectomyCold forceps polypectomyCFPCold snare polypectomyCSP

1) 2) 1 c m 5 m m 3) 6 - 9mm1 - 5mm

follow up follow up 4) Hot polypectomy Cold polypectomy Cold polypectomy 10mm Cold polypectomy

Gastroenterol Endosc 2015572370-8. Toshio URAOKA Technical Tips for Cold Polypectomy for Diminutive and Small Colorectal Polyps.

152 - 8902 2 - 5 - 1

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5) polypectomy Cold polypectomy

polypectomyHot Cold 1 Hot polypectomy Hot biopsypolypectomyEMRendoscopic mucosal resectionHot polypectomy burning effect 6) Hot biopsy 0.26 0.01

2 Cold polypectomyHot polypectomyCold polypectomy 7) 12) Cold polypectomyHot polypectomyCold forceps polypectomy

CFPCold snare polypectomyCSP 2 Cold polypectomy sessile serrated adenoma/polyp 10mmpp polyp Hot polypectomy c EMRCold polypectomy Cold forceps polypectomyCFP simple 2012 13) Cold polypectomy polypectomy 5 7 1 6 1 3 CFPCFPCFP 7) 9) CFP polyp eradication CFP polyp eradication

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data Jung 9) 92CFP EMRfalse negative CFP 3 m m

Jumbo CFP Jumbo Cold polypectomy Radial Jaw4 - Jumbo cold polypectomy 12.4 mm 3 5.3 mm 3 2 Table 1 Figure 1 Jumbo

Jumbo CFP 14) Jumbo Jumbo CFP 15) 5 m m 223 NBI 85 2 m m 100 3 m m 96 4 m m88 5 m m70JumboCFP Figure 2 Jumbo

Jumbo Standard

2.8mm 2.2mm 8.8mm 7.1mm 12.4mm3 5.3mm3 3.2mm 2.8mm

Table 1 Jumbo polypectomy Radial Jaw 4

Figure 1 cold polypectomy Jumbo Radial Jaw 4

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Jumbooozing wa-

ter - jet NBI

Cold snare polypectomyCSPCSP 1992

a b c

d

g

e

h

f

Figure 2 Jumbo cold polypectomy Cold forceps polypectomy.ab 3 m m0 - a c jumbo biopsy de fgwater - jet hNBI

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16) 2005 17) CSP hot polypectomy polypectomy 18) 193 1,015 CSP 11) Horiuchi

hot polypectomy14CSP 19) CSP

a b c

d

g

e

h

f

Figure 3 Cold snare polypectomyab 8 m m0 - sc Captivator 10 mmde f oozing gwater - jet NBI hpolypectomy 3

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CSP Figure 3 1

Captivator 10mmCaptivator Oval 13mmExacto 9 m m/US EndoscopyACEnare 10mmSnareMaster 10mm Figure 4 2 settingCSP

a b c

d eFigure 4 Cold snare polypectomy aCaptivator 10 mmbCaptivator Oval 13 mmcExacto 9 m m/US EndoscopydACEnare 10 mmeSnareMaster 10 mm

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5 6 3 4 Hot snare polypectomy CSP

5 CFPwater - jet CSP CFP oozing

CFP CSP CFPCSP CSP CSP

Ip Isp Is IIa IIc (IIa+IIc)

1-4mm Cold Forceps Polypectomy (CFP) EMR

5-9mm Hot Polypectomy Cold Snare Polypectomy (CSP) EMR

10mm Hot Polypectomy EMR

Table 2

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CFP100CFP Table 2

Hot polyp-ectomyCold polypectomyCold polypectomy Cold polypectomy NBI Cold polypectomy

3D 25

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TECHNICAL TIPS FOR COLD POLYPECTOMY FOR DIMINUTIVE AND SMALL COLORECTAL POLYPS

Toshio URAOKA 1) AND Takahisa MATSUDA 2)

1) Department of Gastroenterology, National Organization Tokyo Medical Center. 2) Endoscopy Division, National Cancer Center Hospital.

Colorectal cancers arise from conventional adenomas via the suppressor pathway that is initi-ated with a mutation of the APC gene, the so-called adenoma-carcinoma sequence. Adequate colonoscopic polypectomy remains as one of the most important interventions during screening colonoscopy in the prevention of colorectal cancer progression and subsequently lowers mortality from colorectal cancer. Actually, most of the detected polyps are diminutive polyps ( 5mm) and small polyps (10mm) in clinical practice. Recently, there have been studies reporting the safety and efficacy of cold polypectomy technique which involves no electrocautery for diminutive and small polyps and this technique has become widely performed especially in Western countries. Cold forceps polypectomy using a jumbo biopsy forceps designed with a greater capacity for re-moving larger tissue samples and cold snare polypectomy with a stiff mini-snare are preferred for diminutive polyps and small polyps, respectively. Cold polypectomy technique is a simple and quick technique allowing complete resection of most diminutive and small polyps provided that the polypectomy site is assessed using narrow band imaging with magnification after water-jet ir-rigation of the targeted area for complete removal.