Biopsy forceps is inadequate for the resection of diminutive polyps

Background and study aims: Cold biopsy forceps polypectomy (CBP) is often used for the removal of diminutive polyps. The efficacy of the technique has not been thoroughly assessed. The aim of this study was to prospectively assess the efficacy of CBP for removing diminutive polyps. Patients and methods: This was a prospective study from St Vincent's Hospital, a tertiary referral hospital in Melbourne, Australia. A total of 143 patients were screened and 52 patients with <= 1 diminutive polyps were enrolled. CBP was used to resect diminutive polyps until no polyp tissue was visible. The polyp base was then resected using endoscopic mucosal resection (EMR) with a 1-2-mm margin. The CBP and EMR samples were compared to assess completeness of the resection. Results: Overall 39% (21/54) of diminutive polyps were completely resected using CBP. After binary logistic regression analysis, polyp histology was found to be predictive of resection, with complete resection of 62% (13/21) for adenomas and 24% (8/33) for hyperplastic polyps (odds ratio 5.1; P = 0.008). The size and number of bites taken with the forceps were not predictive of complete response. Conclusions: Within the limitations of a modest sample size, CBP appears to be inadequate treatment for the removal of diminutive polyps.