The Cold Revolution

Tutticci, Nicholas J.; Kheir, Ammar O.; Hewett, David G.

doi:10.1016/j.giec.2019.06.003

Cited by 12 publications

(10 citation statements)

References 46 publications

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“…3. Endoscopic examination of the cold snare defect margin after resection (23,34). It has been hypothesized that thin-wire monofilament snares alone reduce the IRR.…”

Section: Discussionmentioning

confidence: 99%

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A Randomized Controlled Trial of Cold Snare Polypectomy Technique: Technique Matters More Than Snare Wire Diameter

Sidhu¹,

Forbes²,

Tate

et al. 2021

Am J Gastroenterol

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INTRODUCTION: Cold snare polypectomy (CSP) is safe and effective for the removal of small adenomas (≤10 mm); however, reported incomplete resection rates (IRRs) vary. The optimal CSP technique, where a wide margin of normal tissue is resected around the target lesion, and snare design have both been hypothesized to reduce the IRR after CSP. We sought to investigate the efficacy of a thin-wire versus thick-wire diameter snare on IRR, using the standardized CSP technique. METHODS: This was an international multicenter parallel design randomized trial with 17 endoscopists of varying experience (NCT02581254). Patients were randomized in a 1:1 ratio to the use of a thin-wire (0.30 mm) or thick-wire (0.47 mm) snare for CSP of small (≤10 mm) colorectal polyps. The primary end point was the IRR as determined by the histologic assessment of the defect margin after polypectomy. RESULTS: Over 52 months to January 2020, 1,393 patients were eligible. A total of 660 patients with polyps (57.4% male) were randomized to a thin-wire (n = 339) or thick-wire (n = 321) snare. The overall IRR of the cohort was 1.5%. There was no significant difference in the IRR between the thin- and thick-wire arms; relative risk—0.41, 95% CI (0.11–1.56), P = 0.21. No significant differences were observed in the rate of adverse events. DISCUSSION: In this multicenter randomized trial, CSP is safe and effective with very low rates of incomplete resection independent of the diameter of the snare wire used. This suggests that the optimal operator technique is more important than the snare design alone in minimizing residual adenoma after CSP.

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“…3. Endoscopic examination of the cold snare defect margin after resection (23,34). It has been hypothesized that thin-wire monofilament snares alone reduce the IRR.…”

Section: Discussionmentioning

confidence: 99%

“…Acquisition of a margin of normal tissue (at least 2 mm) around the resected polyp (24,25). Endoscopic examination of the cold snare defect margin after resection (23,34). …”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Cold Snare Polypectomy Technique: Technique Matters More Than Snare Wire Diameter

Sidhu¹,

Forbes²,

Tate

et al. 2021

Am J Gastroenterol

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“…Second, we modeled cold EMR to exclude prophylactic clip closure, as this is the most common practice currently, although it may not be universal 6 7 8 17 18 . Third, recurrences resulting in invasive colorectal cancers were not modeled.…”

Section: Discussionmentioning

confidence: 99%

“…“Cold EMR” has emerged as an alternative to hot EMR owing to its perceived advantage in lowering the rates of adverse events 6 7 8 9 . The documented safety and efficacy of cold snare polypectomy for polyps < 10 mm has led to its gradual adoption for the resection of larger polyps 10 11 12 13 14 15 16 .…”

Section: Introductionmentioning

confidence: 99%

“…The documented safety and efficacy of cold snare polypectomy for polyps < 10 mm has led to its gradual adoption for the resection of larger polyps 10 11 12 13 14 15 16 . Typically, cold EMR involves piecemeal resection of LSCPs without diathermy and, to account for this lack of tissue ablation, cold EMR commonly involves resecting a circumferential border of normal-appearing mucosa (typically > 2 mm) 8 . The avoidance of diathermy markedly reduces the rates of delayed bleeding, therefore many experts currently practicing cold EMR do not routinely use prophylactic clips 6 7 17 18 .…”

Section: Introductionmentioning

confidence: 99%

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Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis

et al. 2021

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Background and Study Aims: For large sessile colorectal polyps (LSCPs), endoscopic mucosal resection without diathermy (“cold EMR”) is gaining popularity due to its safety advantages over conventional EMR (“hot EMR”). Polyp recurrence rates have been reported to be higher with cold EMR. Considering these differences, we performed a cost-effectiveness analysis of these two techniques. Patients and Methods: A decision analysis model was constructed, for EMR of a LSCP. The decision tree incorporated EMR method, clip use, procedural mortality, adverse events and their management, and polyp recurrence. Quality of life was measured in terms of days of lost productivity. Adverse event and recurrence rates were extracted from the existing literature, giving emphasis to recent systematic reviews and RCTs. Results: Through 30 months of follow-up, the average cost of removing a LSCP cold EMR was $5,213, as compared to $6,168 by hot EMR, yielding a $955 USD cost difference (95% Confidence Interval (CI) $903-$1,006). Average days of lost productivity were 6.2 days for cold EMR and 6.3 days for hot EMR. This cost advantage remained over several analyses accounting for variations in recurrence rates and clip closure strategies. Clip cost and LSCP recurrence rate had the greatest, and least impact on marginal cost difference, respectively. Conclusion: Cold EMR is the dominant strategy over hot EMR, with less cost and better quality of life. In theory, a complete transition to cold EMR for LSCPs in the US could result in an annual cost-savings approaching $7 million US dollars to Medicare beneficiaries.

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Endoscopic Mucosal Resection: Colon and Rectum

Kheir

2023

The SAGES Manual Operating Through the Endoscope

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The Cold Revolution

Cited by 12 publications

References 46 publications

A Randomized Controlled Trial of Cold Snare Polypectomy Technique: Technique Matters More Than Snare Wire Diameter

A Randomized Controlled Trial of Cold Snare Polypectomy Technique: Technique Matters More Than Snare Wire Diameter

Cold versus hot endoscopic mucosal resection for large sessile colon polyps: a cost-effectiveness analysis

Endoscopic Mucosal Resection: Colon and Rectum

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