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| Name | Class |
|---|---|
| Jinshan Hospital Fudan University | OTHER |
| Second Affiliated Hospital of Soochow University | OTHER |
| The Third People's Hospital of Yunnan Province | OTHER_GOV |
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This study will evaluate the efficacy and safety of cold snare polypectomy(CSP) and hot snare polypectomy(HSP) in the treatment of colorectal 4-9mm 0-Isp and 0-Ip polyps, and compare the complete resection rate, postoperative late bleeding rate, intraoperative bleeding rate, en bloc resection rate, operation time and the number of metal clips used. The conclusion of this study will help clinical doctor develop more effective resection strategies for colorectal 0-Isp and 0-Ip polyps, and provide more effective treatment for patients.
Colorectal polyps are one of the precancerous lesions of colorectal cancer, 60-80% of which eventually become advanced colorectal cancer. Therefore, early resection of colorectal polyps can effectively reduce the incidence of colorectal cancer. Polyps under white light are judged mainly according to the shape, size and color of polyps. At present, the Paris classification is often used to divide 0-I uplifted polyps into sessile polyps (0-Is), sessile-pedunculated polyps (0-Isp) and pedunculated polyps (0-Ip). It is generally believed that there are thick arteries in 0-Ip polyps, especially thick pedunculated polyps, which are prone to uncontrollable bleeding during operation. 0-Is polyps have small scattered blood vessels and low intraoperative bleeding risk, while the morphological and structural characteristics of 0-Isp polyps are between the two. The current guidelines recommend HSP for 0-Isp and 0-Ip polyps <1 cm, but the internal blood vessels of these polyps are not thick. There is no guidance on whether they can be resected by CSP method, and there is a lack of prospective large sample clinical research. This study will include0-Isp /0-Ip polyps <1cm, and observe the safety and effectiveness of CSP for the above polyp resection , so as to provide reference for the clinical treatment of colorectal polyps.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| cold snare polypectomy group | Other |
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| hot snare polypectomy group | Other |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| cold snare polypectomy | Procedure | Place the special cold snare in the normal mucosa 1-2mm away from the polyp edge. Tighten the snare at a constant speed and gently lift it up and then excision. |
| Measure | Description | Time Frame |
|---|---|---|
| Complete resection rate | The polyps and the two biopsies from the margin will be sent to the pathologist for further analysis. Two independent experienced pathologists will evaluate the samples separately and both are blinded to the technique performed for polypectomy. Complete resection rate is defined as the negative pathological evaluation of two biopsies obtained from the margin. | Up to 5-7 days from operation day |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative delayed bleeding rate | Incidence of bleeding requiring endoscopic hemostasis intervention within 14 days after surgery | Up to 14 days from operation day |
| Intraoperative bleeding rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Taojing Ran, MD | Contact | 8615601942397 | rantaojing@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Duowu Zou, PHD/MD | Ruijin Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Gastroenterolog, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine | Shanghai | Shanghai Municipality | 200025 | China |
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| People's Hospital Mojiang |
| UNKNOWN |
| Shanghai Yueyang Integrated Medicine Hospital | OTHER |
| Huadong Hospital | OTHER |
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| hot snare polypectomy | Procedure | According to evaluation of the polyps, directly place the snare on the edge of the polyp including a clear margin of normal tissue (1-2 mm) or after submucosal injection. Tighten the snare at a constant speed and gently lift it up.Use the electrocoagulation and electroscission mode, power on for several seconds until the polyp is cut off. |
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Immediate bleeding is defined as bleeding persists >60s after polypectomy according to the ESGE recommendations (2017) and requires for endoscopic intervention.
| Up to 1 minute from the time the polyp is resected |
| En bloc resection rate | The lesion is removed at one time, and the integrity of the specimen is maintained | Up to 7 days when the pathologists finish the evaluations. |
| Operation time | CSP: the time from the time the snare exits the working channel to leaving the wound. Hsp: time from the injection needle leaving the working channel to leaving the wound | From the snare/ injection needle exits the working channel to leaving the wound. |
| Other related postoperative complications | Perforation, infection, electrocoagulation syndrome, etc | Up to 48 Hours from the time the polyp is resected |
| Number of metal clips used | Whether metal clips are used for hemostasis, and the number of metal clips | The time when the operation is completed |
| ID | Term |
|---|---|
| D003111 | Colonic Polyps |
| ID | Term |
|---|---|
| D007417 | Intestinal Polyps |
| D011127 | Polyps |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
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