Cold Snare Defect Protrusions Are Associated With Forced Pull-Throughs and Higher Rate of Residual Polyp

Cold snare polypectomy of colorectal polyps sometimes leaves a cord of white tissue consisting of submucosa and, sometimes, muscularis mucosa. These defects are called “cold snare defect protrusions” (CSDPs). CSDPs are more common when an endoscopist forcibly pulls the snare through the tissue, known as “forced cold snare polypectomy” (FCSP).

In a study from Japan of 1315 polyps ≤10 mm in 548 patients, FCSP was necessary for 105 polyps (8%). A CSDP developed in 96.2% of lesions with FCSP compared with 6.4% of lesions without a forced pull-through. There were no perforations with either technique. The mean size of lesions requiring FCSP was 6.0 mm compared with 4.1 mm without forced pull-through. In a multivariable analysis, FCSP was associated with cecal location and size ≥6 mm. The histologic incomplete polyp resection rate was 12.5% with FCSP versus 6.2% in cases not requiring FCSP (P=.02).