Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

Tate, David J.; Awadie, Halim; Bahin, Farzan F.; Desomer, Lobke; Lee, Ralph; Heitman, Steven J.; Goodrick, Kathleen; Bourke, Michael J.

doi:10.1055/s-0043-121219

Cited by 77 publications

(68 citation statements)

References 16 publications

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“…In our analysis, all studies investigated lesions smaller than 10 mm in diameter. Recently, cold snare resection has been applied for larger polyps . In Australia, 34 patients with 41 large sessile serrated polyps (SSPs) (10–35 mm) undertook piecemeal resection using CSP, which showed no significant adverse events and no evidence of recurrence at a median of 6 months .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Jian

et al. 2018

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Jian

et al. 2018

J of Gastro and Hepatol

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“…[11][12][13] SSLs without dysplasia 10-20 mm in size are sometimes resected with piecemeal CSP in Western countries, and some papers have demonstrated the efficacy of piecemeal CSP for SSLs !10 mm. 14,15 However, there is insufficient evidence with regard to the diagnostic accuracy of SSL !10 mm without dysplasia and detailed therapeutic results of those lesions, including recurrence rate, to support the use of CSP for resecting SSLs !10 mm. In the present study, we aimed the feasibility of CSP for SSLs 10-20 mm in size, including diagnostic accuracy, adverse events, local recurrence and risk factors for recurrence.…”

Section: Introductionmentioning

confidence: 99%

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

et al. 2021

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Background and aim Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. Methods This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10–20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10–14 mm in size to those for lesions 15–20 mm in size. Results We analysed 160 lesions in 100 patients ( Mage± SD=67.7±10.1 years). The polyp size ( M± SD) was 11.8±2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12–24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10–14 mm in size and 15–20 mm in size were 4.7% and 6.3%, respectively ( p=0.713). Conclusion CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.

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“…Recently, wide‐field piecemeal cold snare polypectomy has been applied for non‐pedunculated large colon polyps with or without submucosal injection . Perforation is more likely to occur when lesions are removed using endoscopic mucosal resection techniques.…”

Section: Future Of Cold Snare Polypectomymentioning

confidence: 99%

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

Horiuchi

Ikuse

Tanaka

2019

Digestive Endoscopy

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Colonoscopy has been shown to reduce the risk of colon cancer by enabling the removal of precancerous lesions. Although cold snare and hot snare polypectomy have similar retrieval rates and complete resection rates, rates of delayed bleeding tend to be lower with cold snare polypectomy than with hot snare polypectomy, especially for patients taking antithrombotic agents. However, among cold snares there may be differences in terms of the completeness of polyp excision, as complete removal appears more likely with thin‐wire dedicated cold snares compared to the traditional, thick‐wire cold snares. Cold snare polypectomy may be especially well suited for use in patients taking antithrombotic agents, due to its minimal risk of delayed bleeding. Histological analyses suggest that cold snare polypectomy causes less damage to blood vessels in the submucosal layers, which results in a reduced incidence of hemorrhage compared to hot snare polypectomy. However, cold snare removal of small polyps may result in fragmentation of small specimens during collection and concerns as to whether the resection is complete. An endoscopy biomarker of effective cold snare polypectomy technique is needed to ensure complete removal of non‐pedunculated colorectal polyps ≤10 mm. Future uses of cold snare polypectomy may include piecemeal removal of sessile serrated adenoma/polyp lesions >10 mm. Currently, cold snare polypectomy should be considered a primary method for colorectal polyps of less than 10 mm, especially those in the 4‐ to 10‐mm range.

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Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

Abstract: There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding.

Cited by 77 publications

References 16 publications

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Effectiveness and safety of cold versus hot snare polypectomy: A meta‐analysis

Cold snare polypectomy for large sessile serrated lesions is safe but follow‐up is needed: a single‐centre retrospective study

Cold snare polypectomy: Indications, devices, techniques, outcomes and future

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