Extended cold snare polypectomy for small colorectal polyps increases the R0 resection rate

Abstract

Background and study aims Despite widespread use of cold snare polypectomy (CSP), the R0 resection rate is not well documented. We perform extended CSP, resecting polyps with a > 1 mm circumferential margin. The aim of this study is to compare the R0 resection rate of extended CSP with conventional CSP and to assess safety. Patients and methods From April 2014 to September 2016, 712 non-pedunculated colorectal polyps, < 10 mm in size, resected using CSP from 316 patients were retrospectively analyzed. Results We divided lesions into conventional CSP (n = 263) and extended CSP groups (n = 449). The baseline characteristics of these two groups were not significantly different in univariate or multivariate analyses. Sessile polyps comprised 94 % (668/712), and the remaining were flat-elevated polyps. Mean size of polyps (±standard deviation) was 4.2 ± 1.5 mm. The most frequent pathology was low grade adenoma (97 %, 689/712). The R0 resection rate was significantly higher in the extended CSP group (439/449 [98 %]) than in the conventional CSP group (222/263 [84 %], P < 0.001). There was no delayed bleeding or perforation in either group (conventional CSP group, 0/263, 95 % confidence interval: 0.0 – 1.4 % and extended CSP group, 0/449, 95 % confidence interval: 0.0 – 0.8 %). Conclusions Extended CSP results in a higher R0 resection rate compared with conventional CSP. Extended CSP did not result in a higher rate of delayed bleeding or perforation. Extended CSP is a safe and promising procedure for endoscopic resection of non-pedunculated colorectal polyps < 10 mm in size

Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study

“…The thin‐wire snare can cut the mucosa more sharply than the conventional snare; therefore, the cutting time is shorter. CSP with thin‐wire snares may make it possible to collect excisional specimens that include the normal mucosa surrounding the lesion, as reported by Hewett et al 34 and Abe et al 35 …”

Effectiveness of suction valve button removal in retrieving resected colon polyps for better histological assessment: Propensity score matching analysis

“…For the resection method, CSP was performed for the lesions clinically diagnosed as low‐grade adenoma ≤9 mm, and EMR was performed for the lesions clinically diagnosed as high‐grade adenoma or lesions considered to be difficult to resect collectively by CSP, such as ≥10 mm. For each method, >1 mm of the surrounding normal mucosa was included in the resection to secure margin 16 . After resection, the marginal mucosa of the defect was carefully checked to confirm that there was no residual polyp tissue.…”

“…For each method, >1 mm of the surrounding normal mucosa was included in the resection to secure margin. 16 After resection, the marginal mucosa of the defect was carefully checked to confirm that there was no residual polyp tissue.…”

From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s

“…Abe et al [ 67 ] compared extended CSP (with more than 1 mm resection margin) to conventional CSP, showing that the R0 resection rate was significantly higher in the extended CSP group [439/449 (98%)] than in the conventional one [222/263 (84%), P < 0.001]. The main challenge associated with the use of CSP is when the snare fails to cut through the polyp.…”