Cold Snare Resection, at Least Cold EMR, Looks Good for 10- to 19-mm Polyps, Including Adenomas
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Cold Snare Resection, at Least Cold EMR, Looks Good for 10- to 19-mm Polyps, Including Adenomas

Douglas K. Rex, MD, MASGE, reviewing Mangira D, et al. Endoscopy 2023 Feb 7.

Cold snare polypectomy is the accepted treatment of choice for all colorectal polyps smaller than 10 mm and with no suggestion of cancer on endoscopic inspection. Whether cold snare resection can be extended to 10- to 19-mm polyps with good outcomes is uncertain. 

This Australian prospective multicenter trial examined cold snare resection of 10- to 19-mm polyps, with 350 removed in 295 patients over 3 years. Overall, 76% were flat polyps, 68.5% were adenomas, and 31% were sessile serrated lesions (SSLs) or hyperplastic. Incomplete resection based on universal margin and central defect biopsies was positive in 1.7%. First-surveillance colonoscopy was completed in 65% of patients, with the same recurrence rate of 1.7% at a median interval of 9.7 months. Adverse events occurred in 3.4% of patients, including 2 patients with interesting presentations of a postpolypectomy-like syndrome. There were no perforations.

Predictors of incomplete resection included a lack of submucosal injection and more pieces per polyp resection. Incomplete resection occurred in 2.1% of adenomas compared to 1% of SSLs. Incomplete resection occurred in 1% of cases using injection versus 9% without injection.

Douglas K. Rex, MD, FASGE

COMMENT

This study is a useful observational study because there is minimal data regarding cold snare resection of lesions 10 to 19 mm in size, particularly adenomas. Cold snare resection is well established as safer than hot snare resection, and the 2 cases of apparent postpolypectomy syndrome in the study are unusual and unexpected. Because cold snare resection does not require clipping except in rare instances, it should also be more efficient and cost-effective than hot snare resection, which is often followed in clinical practice by clip closure, despite the lack of benefit for clip closure for polyps in this size range.

More data are needed to understand whether injection is truly necessary with meticulous noninjection technique. Noninjection would be more efficient and save the cost and plastic waste of injection catheters and fluids.

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)

Mangira D, Raftopoulos S, Vogrin S, et al. Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for 10-19 mm non-pedunculated colorectal polyps: a multicenter observational cohort study. Endoscopy 2023 Feb 7. (Epub ahead of print) (https://doi.org/10.1055/a-2029-9539)

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