Management of Less Than 10-mm-Sized Pedunculated (Ip) Polyps with Thin Stalk: Hot Snare Polypectomy Versus Cold Snare Polypectomy

Arimoto, Jun; Chiba, Hideyuki; Ashikari, Keiichi; Fukui, Ryo; Tachikawa, Jun; Okada, Nagaya; Suto, Takuma; Kawano, Naoya; Niikura, Toshihiro; Kuwabara, Hiromichi; Nakaoka, Michiko; Ida, Tomonori; Goto, Tetsuhiro; Nakajima, Atsushi

doi:10.1007/s10620-020-06436-7

Cited by 19 publications

(25 citation statements)

References 26 publications

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“…Ιn opposition to this a few studies have been conducted to examine the safety profile of cold snare polypectomy for pedunculated and subpedunculated with encouraging results supporting high level of safety of cold snare excision even for these lesions. [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution

et al. 2022

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Post-polypectomy syndrome or post-polypectomy coagulation syndrome (PPCS) is a rare adverse event of thermal injury caused during hot snare aided, endoscopic mucosal resection of colon polyps. Its diagnosis is tricky as it is commonly misdiagnosed as perforation leading to unnecessary exploratory abdominal surgeries. The authors aim to present an early diagnosed and successfully treated, case of PPCS, and to highlight the difference in the safety profile of two techniques; hot snare versus cold snare polypectomy.

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Section: Discussionmentioning

confidence: 99%

Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution

et al. 2022

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“…61 Several observational studies have shown the efficacy and safety of CSP for pedunculated polyps smaller than 10 mm. [62][63][64]…”

Section: Pedunculated Polypmentioning

confidence: 99%

“…A retrospective observational study showed that pedunculated polyps are a risk for immediate bleeding after CSP 61 . Several observational studies have shown the efficacy and safety of CSP for pedunculated polyps smaller than 10 mm 62–64 . Arimoto et al 65 .…”

Section: Possibility Of Expanding the Indication For Cspmentioning

confidence: 99%

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Ishibashi

Suzuki

Nagai

et al. 2022

Digestive Endoscopy

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It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image‐enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.

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“…At the time of starting this study, there was no previous data on rates of IPPB and DPPB with CSP; however, in the interim, more data was published. [23][24][25]…”

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confidence: 99%

Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps

Fatima

Tariq

Gilmore

et al. 2022

Journal of Clinical Gastroenterology

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Objectives: Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. Materials and Methods: Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. Results: We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P=0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P=0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. Conclusions: CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.

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Management of Less Than 10-mm-Sized Pedunculated (Ip) Polyps with Thin Stalk: Hot Snare Polypectomy Versus Cold Snare Polypectomy

Cited by 19 publications

References 26 publications

Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution

Post-polypectomy coagulation syndrome: a tricky to diagnose hot snare problem that can be eliminated thanks to cold snare revolution

Colorectal cold snare polypectomy: Current standard technique and future perspectives

Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps

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