Is Cold Snare Resection a Good Idea for Duodenal Adenomas?

Is Cold Snare Resection a Good Idea for Duodenal Adenomas?

Vanessa M. Shami, MD, FASGE, reviewing Wang H, et al. Gastrointest Endosc 2023 Jan 27.

Resection of duodenal adenomas (DAs) can be challenging, in part due to the thinness of the duodenal wall and its vascularity. Both postprocedural bleeding (PPB) and perforation are dreaded severe adverse events (SAEs) that can occur when performing traditional hot snare endoscopic mucosal resection (EMR-T). This study evaluates the less-reported cold snare EMR (CS-EMR) for duodenal adenomas versus EMR-T. The primary outcome was SAEs. The secondary outcomes were residual or recurrent adenoma (RRA) at the first surveillance endoscopy (SE1), which was performed at 6 months, and technical success per lesion.  

Between October 2019 and July 2022, 50 consecutive patients with DAs >15 mm in size underwent CS-EMR at a single tertiary center. The outcomes of these patients were prospectively compared with those from a previously reported cohort of 54 patients who underwent EMR-T at the same center. The lesions in the CS-EMR group were lifted with succinylated gelatin, indigo carmine, and diluted epinephrine (1:100,000) and resected with a 10-mm cold snare. The median size of the duodenal adenoma was 30 mm in both groups. 

Patients who received CS-EMR versus EMR-T had significantly lower rates of intraprocedural bleeding (IPB; 2.0% vs 37%; P<.001) and PPB (4.0% vs 16.7%; P=.036). Among those who underwent CS-EMR, 2 (4.0%) sustained perforations, which were immediately recognized and closed with clips. Patients who underwent CS-EMR and EMR-T had similar outcomes for SAEs (16.0% vs 16.7%; P=1) and technical success (100% vs 100%; P=1). Recurrence at SE1 was significantly higher among patients who underwent CS-EMR (24.4% vs 2.3%; P=.002).

Vanessa M. Shami, MD, FASGE


Although CS-EMR reduced IPB and PPB in this study, there was an increased risk of immediate perforation and a higher recurrence rate at SE1 with CS-EMR versus EMR-T. Prospective randomized studies are needed to substantiate these results.



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.


Wang H, Sidhu M, Gupta S, et al. Cold snare endoscopic mucosal resection for the removal of large duodenal adenomas. Gastrointest Endosc 2023 Jan 27. (Epub ahead of print) (

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