Background: Current guidelines recommend cold snare polypectomy (CSP) to remove diminutive colorectal polyps (DCPs)(<5 mm) and small colorectal polyps (SCPs)(6-9 mm) due to a high complete resection rate. Due to the technical difficulty of cold snare polypectomy, many endoscopists preferred cold forceps biopsy for DCPs and SCPs removal. Recent studies demonstrated that jumbo forceps biopsy (JFB), the larger cup forceps, has been proven non-inferior to CSP in removal of DCPs. However, the data on performance of JFB in the resection of SCPs is scarce.
Aim: To investigate the complete resection rate of 3-8 mm polyp by using JFB compared with CSP
Study design: We conducted a prospective, randomized, controlled, single-blinded study. Patients undergoing colonoscopy with at least one 3-8 mm polyp were enrolled from February 2023 to September 2023. The patients were blinded and allocated into JFB and CSP groups. The polyp was resected using JFB (Boston Scientific Radial JawTM4 Forceps, open jaw diameter 8.8 mm, cup volume 12.44 mm³) or CSP (Boston Scientific Captivator Cold 10 mm) until complete resection by endoscopist’s inspection under narrow band imaging. After complete resection by inspection, standard forceps (Boston Scientific RJ4 Biopsy Forceps, open jaw diameter 7 mm, cup volume 5.3 mm³) were used to biopsy at base of the lesion for two pieces and confirmed by the gastrointestinal pathologist as the gold standard. The complete resection was defined as no detection of any part of polyp or dysplasia in the two biopsies at base of the lesion. We recorded the polypectomy time, number of polypectomies to complete resection, tissue retrieval rate, and adverse events.
Results: 150 patients were randomized to JFB group (n=74) and CSP group(n=76). Mean age was 67 years, and 54.7% were female. Total of 299 polyps (136 in JFB and 163 in CSP group) were included. Median size was 4 mm (IQR 3,6), and 73% were DCPs. Polyp characteristics are shown in Table 1. In overall 3-8 mm polyps, complete resection rate was no significant difference between JFB and CSP (91.2% vs. 92%, p=0.79) when subgroup analysis by polyp size, overall complete resection rate in DCPs was 93.6% higher than those in SCPs (86.4%). There is no significant difference in complete resection rate between JFB and CSP in DCPs and SCPs. (Figure 1) Interestingly, JFB had more significant number of polypectomies to complete resection and higher polypectomy time than CSP group. On the contrary, tissue retrieval rate of JFB is 100% higher than those in CSP 98.2% without statistically significant(p=0.25). (Table1) Post-polypectomy bleeding was 9.8% in JFB and 2.6% in CSP.(p=0.1)
Conclusion: JFB had an excellent performance comparable to CSP to achieve complete polyp resection of both DCPs and SCPs sizes up to 8 mm. In insuggestion, JFB can be safely used for SCPs removal.

Varayu Prachayakul

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