Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study

Kimoto, Yoshiaki; Shimizu, Eiji; Inamoto, Rin; Kurebayashi, Marie; Takayanagi, Syunya; Hirata, Tomoya; Suzuki, Yuichiro; Ishii, Rindo; Konishi, Takafumi; Kanda, Keisuke; Negishi, Ryoju; Takita, Maiko; Ono, Kohei; Minato, Yohei; Muramoto, Takashi; Ohata, Ken

doi:10.1016/j.cgh.2020.10.053

Cited by 34 publications

(38 citation statements)

References 29 publications

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“… 29 , 45 In this context, several authors assessed CSP specifically for serrated lesions. 31 , 32 , 33 A systematic review analyzed 1137 SSP ≥ 10 mm compared the outcomes of cold and hot EMR and found a lower residual polyp rate in the cold EMR group in univariate analysis (0.9% vs. 5.0%), although there were no differences in multivariate regression analysis. 44 Since this systematic review, recent studies confirmed low recurrence rates after CSP of SSL (0%–8%; Table 2 ).…”

Section: Current Management For Colorectal Lesionsmentioning

confidence: 99%

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Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

et al. 2021

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Background: Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. Aim:The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy.Results: Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post-polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5-18%. Lower recurrence rates are found in serrated lesions (<8%).

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Section: Current Management For Colorectal Lesionsmentioning

confidence: 99%

“…In this study 474 SSL were resected without submucosal injection and only one recurrent adenoma was found after 7 months follow up. 32 …”

Section: Current Management For Colorectal Lesionsmentioning

confidence: 99%

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

et al. 2021

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“…W E EXTRACTED 15 studies that reported on CSP for large (≥1 cm) colorectal polyps. These included four prospective single arm studies, [39][40][41][42] 10 retrospective studies, [43][44][45][46][47][48][49][50][51][52] and one prospective RCT 20 (Table 3).…”

Section: Cold Procedures For Large (≥1 Cm) Colorectal Polypsmentioning

confidence: 99%

“…Three prospective studies only included large (>10 mm) sessile serrated lesions (SSL), [39][40][41] and one prospective study included polyps measuring 10-15 mm. 42 Two of the studies assessed the completeness of resection by using biopsies from the mucosal defect after CSP, which illustrated excellent endoscopic CRR (98%).…”

Section: Cold Procedures For Large (≥1 Cm) Colorectal Polypsmentioning

confidence: 99%

“…42 Two of the studies assessed the completeness of resection by using biopsies from the mucosal defect after CSP, which illustrated excellent endoscopic CRR (98%). 39,41 Three of the studies assessed the local recurrence rates during surveillance colonoscopy. [39][40][41] Although the follow-up rates were not satisfactory (37-82%), the local recurrence rates were quite low (0-0.6%).…”

Section: Cold Procedures For Large (≥1 Cm) Colorectal Polypsmentioning

confidence: 99%

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Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Takeuchi

Shichijo

Kawakami

et al. 2021

Digestive Endoscopy

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Cold snare polypectomy (CSP; polypectomy without electrocautery) has spread rapidly worldwide during the past decade in what has been called "Cold Revolution". We performed a PubMed literature search for studies investigating CSP outcomes for colorectal polyps. Five randomized controlled trials (RCTs) assessed the complete resection rates (CRRs). The CRRs were similar regardless of the presence or absence of electrocautery, and the efficacy of submucosal injection for better CRRs is still controversial. Eight RCTs assessed the adverse events. The incidence of intraprocedural bleeding with cold procedures was comparable to or higher than that of hot procedures. The incidences of delayed bleeding were comparable to or lower with cold procedures, especially in patients taking anticoagulants. Fifteen studies have been reported on CSP for large (≥1 cm) colorectal polyps (10 retrospective studies, four prospective single-arm studies, and one prospective RCT). These studies reported that the safe cold procedures (a low intra-and post-procedural bleeding rate without perforation) could be implemented for lesions ≥1 cm. However, considering the incision depth of CSP and the local recurrence rate based on the current evidence, only large sessile serrated lesions (SSLs) can be candidates for cold procedures, and large adenomas should not be candidates for this procedure. Based on the current evidence, CSP seems to be the appropriate standard procedure for sub-centimeter colorectal low-grade adenomas due to its safety and simplicity. Thus, large SSLs can be candidates for cold procedures; however, careful inspection and further prospective studies are warranted to confirm the procedure's clinical relevance.

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Comparison of cold snare polypectomy for sessile serrated lesions ≥10 mm between experienced and trainee endoscopists: A propensity score matching cohort study

Kimoto,

Sawada,

Banjoya

et al. 2024

DEN Open

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ObjectivesPrevious studies of cold snare polypectomy (CSP) for sessile serrated lesions (SSLs) ≥10 mm were performed by experienced endoscopists, and therefore their skills might have significantly influenced results. In this study, we compared the efficacy and safety of CSP for SSLs ≥10 mm between experienced and trainee endoscopists.MethodsIn a 1:1 propensity score matched retrospective cohort study, we compared the complete resection rate, en‐bloc resection rate, adverse event rate, and procedure time between experienced and trainee groups. Thirteen endoscopists performed CSP, and we defined the experienced group as endoscopists with board certification from the Japan Gastroenterological Endoscopy Society.ResultsWe examined 616 lesions with SSLs ≥10 mm resected by CSP between February 2018 and May 2022. We excluded 61 lesions from the analysis because they had simultaneously undergone hot snare polypectomy (n = 57) or had been taken over by experienced endoscopists from trainees in the CSP procedure (n = 4). Finally, we identified 217 propensity score‐matched pairs (n = 434). Between experienced and trainee groups, the results were complete resection rate (100 vs. 100%; p = 1.00), en‐bloc resection rate (73.2 vs. 75.6%; p = 0.24), adverse event rate (3.2 vs. 2.8%; p = 0.77), or procedure time (6.2 vs. 5.9 min; p = 0.64).ConclusionsWe have demonstrated the safety and efficacy of CSP for SSLs ≥10 mm performed by experienced and trainee endoscopists.

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Safety and Efficacy of Cold Snare Polypectomy Without Submucosal Injection for Large Sessile Serrated Lesions: A Prospective Study

Cited by 34 publications

References 29 publications

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence

Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Comparison of cold snare polypectomy for sessile serrated lesions ≥10 mm between experienced and trainee endoscopists: A propensity score matching cohort study

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