Randomized Controlled Trial of Thin Versus Thick Cold Snare Polypectomy for Small Polyps: Not Much Difference
Douglas K. Rex, MD, MASGE, reviewing Sidhu M, et al. Am J Gastroenterol 2021 Nov 24.
Cold snare polypectomy is now considered the resection method of choice for colorectal lesions ≤10 mm in size. Dedicated snares with a wire diameter about one-third thinner than standard snares are often used and now commercially available from several companies. In a multicenter randomized trial, 660 patients with lesions ≤10 mm in size had 1 lesion each randomized to cold snare polypectomy using either a thin- or thick-wire snare. After resection, 2 specimens were taken by biopsy from the margin of the mucosal defect to assess completeness of resection.
Margin biopsy results were positive in 0.9% of 339 lesions treated with the thin wire and 2.2% of 321 lesions treated with the thick wire (P=.21). Cold snare protrusion was more common with the thick wire than the thin wire (32.4% vs 25.1%; P=.04).
COMMENTThe authors emphasized training of all 17 endoscopists in accurate snare placement and technique. They consider that their data support their conclusion that technique trumps snare type. Personally, for routine use, I prefer the dedicated cold snare with its thinner wire, especially when numerous lesions must be removed.
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)
Sidhu M, Forbes N, Tate DJ, et al. A randomized controlled trial of cold snare polypectomy technique: technique matters more than snare wire diameter. Am J Gastroenterol 2021 Nov 24. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000001554)
