Cold Snare Resection of Colorectal Polyps: Updates and Recent Developments

Djinbachian, Roupen; Renteln, Daniel von

doi:10.1007/s11938-022-00369-y

Cited by 3 publications

(5 citation statements)

References 75 publications

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“…CSP has seen recent increased popularity due to its favorable safety profile, with current American and European guidelines in many cases recommending its use over HSP or cold forceps 8 13 . There have been many studies evaluating IRRs for standard CSP with varying reported rates of 7 % to 30 % for varying polyp sizes 22 23 24 25 26 27 . A recent meta-analysis of IRRs found 17.3 % [95 % CI 14.3–20.3] IRR for CSP of 1- to 20-mm polyps which was similar to IRRs for HSP 14 .…”

Section: Discussionmentioning

confidence: 99%

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Motchum

Djinbachian²,

Rhame

et al. 2023

Endosc Int Open

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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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Section: Discussionmentioning

confidence: 99%

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Motchum

Djinbachian²,

Rhame

et al. 2023

Endosc Int Open

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“…In recent years, however, there has been a shift in endoscopy practice toward using thin wire snares that have been specifically designed to facilitate polypectomy without requiring hot resection [1]. This so called cold snare resection of polyps <10 mm seems as effective as hot snare resection, with an overall low risk of complications and, in particular, a very low risk of delayed bleeding [2]. A recent survey has shown that the use of cold snare polypectomy has surpassed that of hot snare polypectomy for the removal of colorectal polyps <10mm [1,3].…”

Section: Introductionmentioning

confidence: 99%

“…However, only limited data are available on incomplete resection using a cold snare; most studies have focused on small polyps, and a systematic evaluation of incomplete resection with cold snare for colorectal polyps ≥10 mm from prospective studies is still lacking [2]. The aim of this prospective, multi-endoscopist study was to evaluate incomplete polyp resection when using cold snare for removal of colorectal polyps 4-20 mm.…”

Section: Introductionmentioning

confidence: 99%

“…Because incomplete resection of polyps is a major risk factor for the development of postcolonoscopy colorectal cancer (PCCRC), assuring the completeness of resection is of particular importance [5][6][7][8]. Only limited data are available however on incomplete resection using a cold snare; most studies have focused on small polyps, and a systematic evaluation of incomplete resection using a cold snare for colorectal polyps ≥ 10 mm from prospective studies is still lacking [2]. The aim of this prospective multiendoscopist study was to evaluate incomplete polyp resection when using a cold snare for removal of colorectal polyps of 4-20 mm in size.…”

Section: Introductionmentioning

confidence: 99%

“…Missing data: type of snare, n = 13; ease of resection, n = 7; en bloc resection, n = 12; visible residual tissue after resection, n = 11; bleeding, n = 13 2. All conversions were to hot snare, except for one 9-mm sessile serrated polyp with conversion to cold forceps.von Renteln Daniel et al Incomplete resection of … Endoscopy 2023; 55: 929-937 | © 2023.…”

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Incomplete resection of colorectal polyps of 4–20 mm in size when using a cold snare, and its associated factors

et al. 2022

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Background: Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as first-line modality for small (<10mm) polyps. This study aimed to evaluate incomplete resection rates (IRRs) when using CSP for 4-20mm colorectal polyps. Methods: Adults (45-80y) undergoing screening, surveillance, or diagnostic colonoscopy were included to undergo CSP by nine endoscopists. Primary outcome was IRR for 4-20mm colorectal polyps, defined as presence of polyp tissue in marginal biopsies after resection serrated polyps or adenomas. Secondary outcomes included IRR for serrated polyps, ease of resection and complications. Results: Overall, 413 patients were included (mean age 63; female 48.2%) and 182 polyps 4-20mm were detected and removed by CSP. CSP required conversion to hot snare resection in <1% of polyps <10mm and 44.4% of polyps 10-20mm. IRR for polyps <10mm and ≥10mm was 18.4% and 21.4%. IRR was higher for serrated polyps (25.6%) compared to adenomas (15.7%). IRR was higher for flat (IIa) polyps (OR=2.9, 95% Confidence Interval [CI]=1.13-7.41), when resection was judged as difficult (OR=4.2, 95%CI=1.47-12.13), when piecemeal resection was performed (OR=6.6, 95%CI=1.97-22.01), or when visible residual polyp was present after initial resection (OR=5.4, 95%CI=1.97-14.88). Polyp location, using a dedicated cold snare, or submucosal injection was not associated with incomplete resection. Intraprocedural bleeding requiring endoscopic intervention occurred in 4.7%. Conclusions: CSP for 4-9mm polyps is safe and feasible. However, for lesions ≥10mm, CSP failure occurs frequently, and IRR remains high even after technical success. Incomplete resection was associated with flat polyps, visual residual polyp, piecemeal resection, and difficult polypectomies.

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Local recurrence rates after resection of large colorectal serrated lesions with or without margin thermal ablation

Djinbachian,

Amar,

Pohl

et al. 2023

Scandinavian Journal of Gastroenterology

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Cold Snare Resection of Colorectal Polyps: Updates and Recent Developments

Cited by 3 publications

References 75 publications

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Incomplete resection rates of 4- to 20-mm non-pedunculated colorectal polyps when using wide-field cold snare resection with routine submucosal injection

Incomplete resection of colorectal polyps of 4–20 mm in size when using a cold snare, and its associated factors

Local recurrence rates after resection of large colorectal serrated lesions with or without margin thermal ablation

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