Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?

Abstract

Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide. 1 Colonoscopy plays an essential role in the prevention of the development of CRC and death. 2 Most polyps identified at colonoscopy do not cause harm to patients. In most cases, the adenoma-carcinoma sequence progresses slowly. However, the malignant potential of individual polyps is unknown, and even small/diminutive polyps can occasionally harbor cancer. Therefore, all polyps (even diminutive rectal polyps) should be removed. Although colorectal polypectomy has few adverse events, post-polypectomy bleeding and perforation pose a serious risk to the patient. Owing to the prophylactic nature of most polypectomies, the risk-benefit ratio is not well balanced should an adverse event occur after the procedure. Cold snare polypectomy (CSP), a polypectomy method that does not use electrocautery, has rapidly gained popularity in recent years because of its safety. 3 Since CSP does not involve electrocautery, the risk of residual polyps has been a concern-that it would increase residual polyps compared to conventional resection methods. Matsuura et al. reported that additional endoscopic mucosal resection COMMENTARY