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Yoshida N, Naito Y, Murakami T, et al. A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy. Case Rep Gastroenterol. 2018;12(1):27-31doi: 10.1159/000486128.
Yoshida, N., Naito, Y., Murakami, T., Ogiso, K., Hirose, R., Inada, Y., Kishimoto, M., Rani, R. A., & Itoh, Y. (2018). A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy. Case reports in gastroenterology, 12(1), 27-31. https://doi.org/10.1159/000486128
Yoshida, Naohisa, et al. "A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy." Case reports in gastroenterology vol. 12,1 (2018): 27-31. doi: https://doi.org/10.1159/000486128
Yoshida N, Naito Y, Murakami T, Ogiso K, Hirose R, Inada Y, Kishimoto M, Rani RA, Itoh Y. A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy. Case Rep Gastroenterol. 2018 Jan 19;12(1):27-31. doi: 10.1159/000486128. eCollection 2018. PMID: 29515342; PMCID: PMC5836183.
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Case Rep Gastroenterol. 2018 Jan 19;12(1):27-31. doi: 10.1159/000486128. eCollection 2018.

A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy.

Case reports in gastroenterology

Naohisa Yoshida, Yuji Naito, Takaaki Murakami, Kiyoshi Ogiso, Ryohei Hirose, Yutaka Inada, Mitsuo Kishimoto, Rafiz Abdul Rani, Yoshito Itoh

Affiliations

  1. aDepartment of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
  2. bDepartment of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
  3. cGastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia.

PMID: 29515342 PMCID: PMC5836183 DOI: 10.1159/000486128

Abstract

Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surgeon thought the polyp could be completely resected by CSP. It was thoroughly resected, and a histological examination showed submucosal cancer with a positive vertical margin. Additional surgical resection was not accepted by the patient, since he had received total gastrectomy for gastric cancer and a right hemicolectomy for colonic cancer in the past 7 years. He underwent follow-up colonoscopy 2 months after the CSP. Although there were no recurrent endoscopic findings, endoscopic submucosal dissection was performed to the scar area. The histological examination showed no residual tumor. In conclusion, CSP should only be adopted for benign cases, as cancerous lesions have a possibility for invading the submucosa, like in our case.

Keywords: Cold snare polypectomy; Colorectal cancer; Diminutive polyp; T1 cancer

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