Colorectal cold snare polypectomy: Current standard technique and future perspectives

Abstract

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.

Editorial: Optimizing the success of cold snare polypectomy in colonoscopy practice

“…This is important, as there have been an increasing number of studies reporting the application of CSP in lesions larger than 10 mm or even larger than 20 mm. 7 Because the risk of high-grade dysplasia (HGD) or invasive cancer increases along with size, an unclear horizontal or vertical margin may increase the risk of PCCRC. Though CSP does not apply electrocautery and reduces the likelihood of cautery effect affecting margin assessment, reconstruction of multiple tumor specimens after piecemeal CSP is still challenging, and failure of specimen retrieval may cause underdiagnosis of HGD or invasive cancer.…”

“…Histopathological studies have shown that CSDPs are in the muscularis mucosa, and it may be an indicator of incomplete resection and is often associated with specimen fragmentation. 7 In this issue of Journal of Gastroenterology and Hepatology, Horii et al performed a randomized controlled study and reported that CSP using a thinner diameter of snare wire could achieve a significantly higher histological complete resection rate compared with that using a normal-diameter snare (70% vs 81%, P = 0.04). 9 In a subanalysis of results based on level of experience, it is noteworthy that more experienced endoscopists appeared to have a higher complete resection rate than trainees.…”

“…Second, the horizontal margin was seldom reported in previous studies. This is important, as there have been an increasing number of studies reporting the application of CSP in lesions larger than 10 mm or even larger than 20 mm 7 . Because the risk of high‐grade dysplasia (HGD) or invasive cancer increases along with size, an unclear horizontal or vertical margin may increase the risk of PCCRC.…”

“…Third, when resection of the lesion could not be easily achieved by CSP, it is sometimes resected by forcefully pulling on the snare, leading to cold snare defect protrusions (CSDP). Histopathological studies have shown that CSDPs are in the muscularis mucosa, and it may be an indicator of incomplete resection and is often associated with specimen fragmentation 7 …”

Dietary restriction after cold snare polypectomy of colorectal polyp for prevention of delayed bleeding

“…8 The technique to resect polyps should be easy, safe, and effective; hence, cold snare polypectomy (CSP) is becoming the first choice for the resection of small polyps. 9 Several reports have demonstrated increased safety of CSP for small polyps compared to hot snare polypectomy. 10,11 It was hypothesized that starting diet immediately after the resection of colorectal polyps would increase the risk of delayed bleeding.…”