Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Chandrasekar, Viveksandeep Thoguluva; Spadaccini, Marco; Aziz, Muhammad; Maselli, Roberta; Hassan, Syed Ibrahim; Fuccio, Lorenzo; Duvvuri, Abhiram; Frazzoni, Leonardo; Desai, Madhav; Fugazza, Alessandro; Jegadeesan, Ramprasad; Colombo, Matteo; Dasari, Chandra S.; Hassan, Cesare; Sharma, Prateek; Repici, Alessandro

doi:10.1016/j.gie.2018.12.022

Cited by 98 publications

(82 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…34 There has been a concerted effort to expand the use of CSP to large nonpedunculated polyps (≥10 mm). Recent systematic reviews and pooled-analyses 36,37 showed excellent rates of resection comparable to those of HSP, with lower rates of delayed PPB than those of HSP. There were higher rates of immediate PPB with polyps ≥20 mm, which were effectively managed during the procedure.…”

Section: Prevention Of Post-polypectomy Bleedingmentioning

confidence: 99%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

View full text Add to dashboard Cite

Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.Clin Endosc 2020;53:302-310

show abstract

Section: Prevention Of Post-polypectomy Bleedingmentioning

confidence: 99%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

View full text Add to dashboard Cite

show abstract

“…The risk of intraprocedural bleeding needs to be considered, and minor bleeding can be expected to be common, although in our in vivo porcine model study, this was not proven to be the case. In series reporting piecemeal cold resection of large flat lesions (> 20 mm), risk of significant bleeding has been shown to be very low (0.7 – 1.3 % intraprocedural, 0 – 0.5 % delayed) 1 . Therefore, we would not anticipate an increase in significant bleeding with C-ESD.…”

Section: Discussionmentioning

confidence: 99%

“…Use of cold endoscopic resection techniques has recently increased due to their safety. Piecemeal cold snare has proven safe and effective for large flat lesions 1 2 3 . The advantages of avoiding cautery are well known, but lesion size represents a major limitation for cold “en bloc” resection.…”

Section: Introductionmentioning

confidence: 99%

Is it time for Cold-Endoscopic Submucosal Dissection? A feasibility study in an esophageal and colorectal live porcine model

Parra‐Blanco

Fraile-López

2020

Endosc Int Open

View full text Add to dashboard Cite

Background and study aims Use of cold endoscopic resection has increased due to excellent results with it and the ability to avoid electrosurgery related complications. The aim of this study was to evaluate the feasibility and safety of cold-endoscopic submucosal dissection (C-ESD) in an in vivo porcine model. Patients and methods C-ESD with circumferential incision and submucosal dissection with a predominantly cold technique was tested in the esophagus and colorectum. Incision and dissection were attempted with a cold technique with a biopsy forceps and an endoscopic Maryland dissector. Large vessels were pre-coagulated with the latter device. Different traction methods were applied. Results Twelve dissections were performed: four esophageal, four colonic, and four rectal. Tunnel and pocket methods were applied successfully. Full C-ESD was possible in the colorectum. In the esophagus, an initial incision had to be done with electrocautery. No major bleeding occurred. Two perforations occurred in the colon, one was endoscopically treated. Conclusions Full C-ESD is feasible in the colorectum, whereas a small hot incision is needed in the esophagus. However, in 50 % of the colonic cases, there were perforations caused by the biopsy forceps making the circumferential incision. Therefore, potential benefits of endoscopic resection without cautery would warrant futures studies in humans initially in esophagus and rectal locations.

show abstract

“…To our knowledge, this is the first report of a successful salvage using ESD for residual colorectal cancer after CSP. Colonoscopy and the removal of neoplastic polyps are very effective for colorectal cancer prevention [1,2], and CSP is a well-established method, owing to its safety, for the resection of colorectal polyps measuring less than 10 mm [3,4]. The adaptation limit of lesion size in CSP is because of its en-block resection ability [3,4] and the low frequency of carcinomas.…”

Section: Discussionmentioning

confidence: 99%

“…Colonoscopic removal of a neoplastic polyp is the most effective therapeutic measure for colorectal cancer prevention [1,2]. Cold snare polypectomy (CSP) is a well-established method for the resection of colorectal polyps measuring less than 10 mm, as it is associated with a low frequency of post-procedural bleeding and perforation [3,4]. Although the proportion of malignancy in colorectal neoplastic lesions measuring less than 10 mm is considered very low, small lesions with advanced histology have been reported [5].…”

Section: Introductionmentioning

confidence: 99%

Case of Colorectal Cancer After Cold Snare Polypectomy Successfully Salvaged on Endoscopic Submucosal Dissection

Katagiri

Inoki

Konda

et al. 2020

Cureus

View full text Add to dashboard Cite

Cold snare polypectomy is a well-established method for the resection of colorectal polyps measuring less than 10 mm in size. It may be performed in patients with early colorectal cancers because of the difficulty of endoscopic diagnosis. However, the therapeutic effect of cold snare polypectomy on cancers is unknown, and the need for appropriate surveillance and additional treatment for these patients remains to be fulfilled. Endoscopic submucosal dissection has been reported as a safe and effective method for treating recurrent or residual colorectal neoplasia following hot endoscopic mucosal resection. This report is of a case of a colorectal tumor measuring 8 mm that was treated using cold snare polypectomy and resulted in residual cancer. Endoscopic submucosal dissection was selected as salvage treatment for the residual lesion, and histopathological examination revealed free horizontal and vertical margins. We believe that performing endoscopic submucosal dissection at the site of the cancer resected with cold snare polypectomy ensured that there was no residual cancer left. It may be hypothesized that endoscopic submucosal dissection could evolve as the treatment of choice for patients with colorectal cancer after cold snare polypectomy.

show abstract

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Cited by 98 publications

References 33 publications

Endoscopic Management of Post-Polypectomy Bleeding

Endoscopic Management of Post-Polypectomy Bleeding

Is it time for Cold-Endoscopic Submucosal Dissection? A feasibility study in an esophageal and colorectal live porcine model

Case of Colorectal Cancer After Cold Snare Polypectomy Successfully Salvaged on Endoscopic Submucosal Dissection

Contact Info

Product

Resources

About