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There are limited data regarding the safety and efficacy of cold snare polypectomy (CSP) for large colorectal polyps. We evaluated factors affecting the clinical outcomes of CSP for polyps between 5 and 15 mm in size. This was a prospective single-center observational study involving 1000 patients undergoing colonoscopy. Polyps (5–15 mm) were removed using CSP, and biopsies were taken from the resection margin. The primary outcome was the incomplete resection rate (IRR), and was determined by the presence of residual neoplasia on biopsy. Correlations between IRR and polyp size, morphology, histology, and resection time were assessed by generalized estimating equation model. A total of 440 neoplastic polyps were removed from 261 patients. The overall IRR was 2.27%, 1.98% for small (5–9 mm) vs 3.45% for large (10–15 mm) polyps (P =.411). In univariate analysis, the IRR was more likely to be related to sessile serrated lesions (odds ratio [OR], 6.93; 95% confidence interval [CI], 1.88–25.45; P =.004), piecemeal resection (OR, 11.83; 95% CI, 1.20–116.49; P =.034), and prolonged resection time >60 seconds (OR, 7.56; 95% CI, 1.75–32.69; P =.007). In multivariable regression analysis, sessile serrated lesions (OR, 6.45; 95% CI, 1.48–28.03; P =.013) and resection time (OR, 7.39; 95% CI, 1.48–36.96; P =.015, respectively) were independent risk factors for IRR. Immediate bleeding was more frequent with resection of large polyps (6.90% vs 1.42%; P =.003). No recurrence was seen on follow-up colonoscopy in 37 cases with large polyps. CSP is safe and effective for removal of colorectal polyps up to 15 mm in size, with a low IRR. (ClinicalTrials.gov ; Number: NCT03647176). [Display omitted] [ABSTRACT FROM AUTHOR]

The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to stratify the risk of colorectal advanced neoplasm (AN). We aimed to evaluate the performance of the APCS score combined with a stool DNA test used for colorectal cancer screening. A total of 2842 subjects who visited outpatient clinics or cancer screening centers were enrolled. Age, sex, smoking status, and family history were recorded and APCS scores were calculated in 2439 participants. A stool DNA test (SDC2 and SFRP2 tests) and fecal immunochemical test (FIT) were performed and colonoscopy was used as the gold standard among 2240 subjects who completed all study procedures. We used a threshold of 4.4 μg/g for the FIT, in addition to the manufacturer's recommended threshold of 20 μg/g to match the specificity of a stool DNA test. Based on the APCS score, 38.8% (946 of 2439) of the subjects were categorized as high risk, and they had a 1.8-fold increase in risk for AN (95% CI, 1.4–2.3) compared with low and moderate risk. The APCS combined with the stool DNA test detected 95.2% of invasive cancers (40 of 42) and 73.5% of ANs (253 of 344), while the colonoscopy workload was only 47.1% (1056 of 2240). The sensitivity for AN of APCS combined with stool DNA test was significantly higher than that of APCS combined with FIT (73.5% vs 62.8% with FIT cut-off value of 20 μg/g, and 73.5% vs 68.0% with FIT cut-off value of 4.4 μg/g; both P <.01). The APCS score combined with a stool DNA test significantly improved the detection of colorectal ANs, while limiting colonoscopy resource utilization (Chictr.org.cn, ChiCTR-DDD-17011169). ▪ [ABSTRACT FROM AUTHOR]