Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Large colonic polyps (>1cm) are typically managed with hot polypectomy.
• Hot polypectomy carries risks of adverse events like bleeding, perforation, and post-polypectomy syndrome due to electrocautery injury.
• Cold resection techniques are being explored as potentially safer alternatives.

Purpose of the Study:

• To evaluate the efficacy and safety of piecemeal cold snare resection for colonic polyps larger than 1cm.
• To compare the outcomes of cold snare resection with existing data on hot polypectomy.

Main Methods:

• Retrospective review of patients undergoing piecemeal cold snare resection for non-pedunculated colonic polyps >1cm (October 2013 - September 2015).
• Efficacy assessed by absence of residual adenomatous tissue on follow-up endoscopy.
• Adverse events (bleeding, perforation, pain requiring hospitalization) evaluated via chart review and telephone follow-up.

Main Results:

• 73 patients underwent resection of 94 polyps; 56 patients completed follow-up for 72 polyps.
• Residual or recurrent adenoma was detected in 7 cases (9.7%), associated with larger polyp size (median 37.1mm vs. 19.1mm).
• No adverse events were reported among the 73 patients.

Conclusions:

• Piecemeal cold snare resection of large colonic polyps (>1cm) is feasible, safe, and effective based on this study.
• The technique shows promise as a potentially safer alternative to hot polypectomy.
• Further comparative studies are needed to confirm adenoma eradication rates and safety advantages.