Cold Snare Polypectomy Failed to Achieve Complete Resection in 11% of 4- to 9-mm Polyps
Douglas K. Rex, MD, MASGE, reviewing Pedersen IB, et al. Endoscopy 2022 Jan 10.
In a randomized controlled trial (RCT) performed at 8 hospitals in 4 countries, patients with nonpedunculated polyps ranging in size from 4 to 9 mm were randomized 1:1 to cold snare polypectomy (CSP) versus hot snare polypectomy (HSP). There were 318 polyps removed by CSP and 283 removed by HSP, with incomplete resection rates of 10.7% and 7.4%, respectively. The adjusted risk difference of 3.2% was not significant. Incomplete resection was determined by 2 biopsies from the margins of 4- to 6-mm lesions and 3 biopsies from the margins of 7- to 9-mm lesions. There were no significant complications in either arm. Overall rates of incomplete resection were 5.8% for adenomas, 22.5% for sessile serrate lesions (SSLs), and 13.9% for hyperplastic polyps. The odds ratios for incomplete resection were 3.96 for lesions with SSL histology and 2.52 for hyperplastic histology.
COMMENTThe absolute rates of incomplete resection are higher here than seen in previous RCTs, which might reflect fewer expert colonoscopists. Another possibility is standard resolution instruments or inadequate training to identify serrated pits at the margins of resections. There could also have been inadequate willingness to take wide margins. Cold snare polypectomy should be extremely effective in polyps within this size range if the snare is placed accurately to take a wide margin and a high-definition instrument is used to ensure resection of all abnormal pits.
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)
Pedersen IB, Rawa-Golebiewska A, Calderwood AH, et al. Complete polyp resection with cold versus hot snare polypectomy for polyps sized 4-9 mm: a randomized controlled trial. Endoscopy 2022 Jan 10. (Epub ahead of print) (https://doi.org/10.1055/a-1734-7952)
