Safety and Feasibility of Intensive Downstaging Polypectomy With Low‐Power Pure‐Cut Hot Snare Polypectomy in Patients With Familial Adenomatous Polyposis (With Video)

Intensive endoscopic resection for downstaging polyp burden (IDP) strategically prevents colorectal cancer and potentially avoiding surgical treatment in patients with familial adenomatous polyposis (FAP). The safety and efficacy of low-power pure-cut hot-snare polypectomy (LPPC-HSP) for sporadic colorectal polyps have been recently reported. This prospective study, therefore, aimed to clarify the safety and efficacy of IDP in combination with LPPC-HSP in patients with FAP. This single-centre prospective study recruited patients diagnosed with FAP and scheduled for IDP. The primary outcome was the rate of severe adverse events including postoperative bleeding and perforation. The secondary outcomes were adverse events per the Clavien-Dindo classification, abdominal pain, hematochezia after the procedure, emergency colonoscopy, and rehospitalization. Patients with FAP who underwent IDP with conventional hot snare polypectomy using bipolar snares from January 2021 to December 2021 were examined as historical controls (bipolar group) for comparison with patients who underwent IDP with LPPC-HSP (LPPC-HSP group). Among 36 patients with FAP enrolled between July 2023 and June 2024, 33 were included in the analysis. The median age was 31 years, and 16 patients were male. A total of 6581 polyps were resected. Two patients (one with postoperative bleeding and the other with postoperative bleeding and delayed perforation) in the LPPC-HSP group (n = 33) and four patients (all with postoperative bleeding) in the bipolar group (n = 37) experienced severe adverse events (p = 0.677). In conclusion, LPPC-HSP is feasible and may be considered a treatment option for patients with FAP undergoing IDP. TRIAL REGISTRATION: UMIN-CTR: UMIN000051414.