Generic filters

Sessile Serrated Lesions That Are 10 mm or Larger: No Need To Inject

Douglas K. Rex, MD, MASGE, reviewing Kimoto Y, et al. Clin Gastroenterol Hepatol 2020 Nov 2.

Cold resection of sessile serrated lesions (SSLs) ≥10 mm in size is increasingly accepted as effective and, compared to electrocautery, is safer. Many experts prefer cold endoscopic mucosal resection (EMR) because the contrast delineates the lesion borders. 

A single Japanese center reported the outcomes of 300 consecutive patients who underwent cold snare polypectomy without injection for 474 SSLs ≥10 mm. In cases where the border was unclear, indigo carmine chromoendoscopy or image-enhanced endoscopy was used to define the border.

Median SSL size was 14 mm (range, 10-40 mm), and only 106 (22%) lesions were treated with piecemeal resection (median, 3 pieces; range, 2-6 pieces). Resections were performed using a 10-mm- or 12-mm-diameter snare. Biopsy samples taken from the defect margin revealed residual polyp in only 1 lesion. Intraprocedural bleeding occurred in 8 (3%) patients. There were no other adverse events, including delayed bleeding, perforation, or postpolypectomy syndrome. A total of 384 (81%) lesions were followed at a median of 7 months, with no local recurrences detected.

Douglas K. Rex, MD, FASGE


Although there are still no randomized comparisons of cold EMR versus cold resection without injection for SSLs ≥10 mm, there is currently no reason to believe that one method is more effective and the noninjection approach would have lower costs.

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.


Kimoto Y, Sakai E, Inamoto R, et al. Safety and efficacy of cold snare polypectomy without submucosal injection for large sessile serrated lesions: a prospective study. Clin Gastroenterol Hepatol 2020 Nov 2. (Epub ahead of print) (

Scroll to Top