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Introduction: Incomplete resection of 4–20mm colorectal polyps occur frequently (>10%), putting patients at risk for post-colonoscopy colorectal cancer. We hypothesized that routine use of wide-field cold snare resection with submucosal injection (CSP-SI) might reduce incomplete resection rates (IRRs). Methods: Patients 45–80 years undergoing elective colonoscopies were enrolled in a prospective clinical study. All 4–20mm non-pedunculated polyps were resected using CSP-SI. Post-polypectomy margin biopsies were obtained to determine IRR through histopathology assessment. Primary outcome was IRR, defined as remnant polyp tissue found on margin biopsies. Secondary outcomes included technical success and complication rates. Results: A total of 429 patients (median age 65 years, 47.1% female, adenoma detection rate 40%) with 204 non-pedunculated colorectal polyps 4–20mm removed using CSP-SI were included in the final analysis. CSP-SI was technical successful in 97.5% (199/204) of cases (5 conversion to hot snare polypectomy). IRR for CSP-SI was 3.8% (7/183) [95% CI 2.7–5.5%]. IRR was 1.6% (2/129), 16% (4/25), and 3.4% (1/29) for adenomas, serrated lesions, and hyperplastic polyps respectively. IRR was 2.3% (2/87), 6.3% (4/64), 4.0% (6/151), and 3.1% (1/32) for polyps 4–5mm, 6-9mm, <10mm, and 10–20mm respectively. There was no CSP-SI-related serious adverse event. Conclusion: Use of CSP-SI results in lower IRRs compared to what has previously been reported in the literature for hot or cold snare polypectomy when not using wide-field cold snare resection with submucosal injection. CSP-SI showed an excellent safety and efficacy profile, however comparative studies to CSP without SI are required to confirm these results.

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