Efficacy and safety of cold snare resection in preventive screening colonoscopy

Abstract

Background and aim Removal of polyps during colonoscopy effectively prevents the development of colorectal cancer. So far, snare resection with high frequency current with or without prior submucosal saline injection is the method of choice. The aim of this study was to evaluate the feasibility, safety, and outcome of cold snare resection during routine endoscopy. Methods In this prospective study, 522 patients undergoing outpatient colonoscopy were included. Cold snare resection for diminutive (< 6 mm), small (6 – 9 mm), and larger polyps (> 9 – 15 mm) was performed using a dedicated cold snare device (Exacto ® ) without prior submucosal injection. Outcome parameters included bleeding rate, perforation rate, procedure time, histologic evaluation of polyp margins, and success rates. The data were compared to a group of patients undergoing hot snare resection. Results Overall, 1233 polyps were removed using cold snare resection with an overall success rate of 99.4 %. All failures of cold snare resection occurred in the cecum (8/82, failure rate 9.8 %). In the remaining colon, the success rate was 100 %. Immediate post-polypectomy bleeding occurred in 0.49 % of all patients and was most frequently seen in polyps larger than 9 mm. The procedure time was significantly shorter using cold snare resection compared with hot snare resection (27.6 min vs. 35.7 min, P < 0.01). Conclusion Cold snare resection can be performed safely in outpatients for removal of small polyps in screening colonoscopy. It does not require prior saline injection and reduces procedure time without an increased risk of bleeding.

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

“…Based on the title and abstract, 816 irrelevant studies were excluded. Evaluation of the full text of the remaining studies excluded eight more: observational studies ( n = 4), comparison with cold forceps ( n = 3) and comparison with hot forceps ( n = 1) . The remaining eight studies were included in this meta‐analysis …”

Indications for Cold Polypectomy Stratified by the Colorectal Polyp Size: A Systematic Review and Meta-Analysis

“…The polyp retrieval rate was defined as the ratio of the specimen obtained for pathological evaluation [15]. Delayed bleeding was defined as bleeding requiring medical treatment or emergency endoscopy after examinations [4,16,17].…”

“…The reasons for exclusion were as follows: retrospective analysis [20,21] (n = 2); comparison with hot forceps biopsy [22] (n = 1); comparison with a suction pseudopolyp technique [23] (n = 1); and nonrandomized controlled trial [24] (n = 1). Finally, 12 randomized controlled trials [13][14][15][25][26][27][28][29][30][31][32][33]] and 3 prospective observational studies [4,16,17] were extracted. We did not conduct funnel plot analyses for publication bias because there were fewer than 10 trials [34].…”

“…10 mm, whereas the study comparing CSP and CFP mainly focused on smaller polyps. In all the studies, except for that by Schett et al [17], polyp size was estimated comparing the snare, forceps, or endoscopic measurement device. In 8 randomized controlled trials with complete or incomplete resection rates as the primary endpoint [13,25,26,[29][30][31][32][33], the completeness of resection was evaluated by biopsy (n = 6), EMR (n = 1), or cold snaring (n = 1) at the resection site.…”

Efficacy of small colon polyps (less than 10 mm) cold polypectomy methods at diagnostic colonoscopy in out-patient clinic

“…вклейке). Можно предположить также и сложность изучения удаленного фрагмента при гистологическом исследовании, что затрудняет оценку радикальности проведенного вмешательства [16,17]. К недостаткам «горячей» резекции также относятся повышенный риск перфорации и пострезекционного серозита; развитие отсроченных кровотечений, особенно в слепой и восходящей ободочной кишке; коагуляционный некроз удаленного образца опухоли, который априори имеет небольшие размеры.…”