Underwater cold snare polypectomy for colorectal adenomas

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Cold snare polypectomy (CSP) is a standard treatment for colorectal adenomas.
• Current CSP methods often have insufficient R0 resection rates due to inadequate removal of the muscularis mucosa.
• Underwater techniques may improve resection depth and completeness.

Purpose of the Study:

• To evaluate the efficacy and safety of underwater cold snare polypectomy (UCSP) for colorectal adenomas.
• To compare UCSP with conventional CSP in terms of R0 resection and pathological outcomes.

Main Methods:

• Prospective study of patients undergoing UCSP for colorectal adenomas (<9 mm) between May 2017 and April 2018.
• Follow-up colonoscopy with biopsies of post-polypectomy sites.
• Comparison with a historical control group using conventional CSP via propensity score-matching.

Main Results:

• UCSP successfully resected 224 lesions in 65 patients, with a low residual adenoma rate (1.0%).
• No complications were observed during the UCSP procedure.
• UCSP demonstrated significantly higher R0 resection rates (80.2% vs. 32.7%) and rates of muscularis mucosa inclusion (50.0% vs. 35.3%) compared to CSP.

Conclusions:

• Underwater cold snare polypectomy is a safe and effective endoscopic procedure for diminutive and small colorectal adenomas.
• UCSP facilitates achieving adequate resection depth, leading to improved pathological complete resection.
• The enhanced R0 resection rate suggests UCSP is a valuable advancement in adenoma management.