Cold Snare Looks Good for Pedunculated Polyps Smaller Than 10 mm
Douglas K. Rex, MD, MASGE, reviewing Canakis A, et al. J Clin Gastroenterol 2023 Mar 30.
This systematic review and meta-analysis identified 6 studies with 1025 patients and 1111 polyps with a mean size ranging from 4 to 8.5 mm. Cold snare polypectomy (CSP) was used to remove 995 polyps, and hot snare polypectomy (HSP) was used with 116 polyps.
The en bloc resection rate was 99.7% with CSP. Immediate and delayed bleeding rates with CSP were 49.8% and 0%, respectively. The corresponding rates for HSP were 6.9% and 4.4%, respectively. Clips were placed on about half of the lesions after CSP, but the rates across studies ranged from 6% to 99%. Immediate bleeding was more common with right-sided colon lesions and was not affected by antithrombotic or antiplatelet medications.
COMMENTThese data support cold snare polypectomy as an appropriate approach to pedunculated colorectal polyps <10 mm. Immediate bleeding generally stops if ignored for a short period, or it can be stopped by pumping water into the submucosa with the water jet, putting direct pressure on the site with the colonoscope tip, or regrasping the site and squeezing it with the snare. Clip placement should be necessary for only a small fraction of lesions.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Canakis A, Chandan S, Bapaye J, et al. Cold snare polypectomy and small (< 10 mm) pedunculated colorectal polyps: a systematic review and meta-analysis. J Clin Gastroenterol 2023 Mar 30. (Epub ahead of print) (http://doi.org/10.1097/MCG.0000000000001848)
