Does cold snare polypectomy completely resect the mucosal layer? A prospective single-center observational trial

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Pathology

Background:

• The incidence of incomplete muscularis mucosa resection during cold snare polypectomy (CSP) is not well-established.
• Cold snare defect protrusion (CSDP) is a potential indicator of incomplete resection, but its precise role requires further investigation.

Purpose of the Study:

• To determine the incidence of incomplete muscularis mucosa resection associated with CSP.
• To evaluate the correlation between cold snare defect protrusion (CSDP) and incomplete resection during CSP.

Main Methods:

• Prospective enrollment of patients undergoing polypectomy for 4-9mm non-pedunculated polyps.
• Histological evaluation of biopsies from the mucosal defect, with or without CSDP, to assess for residual muscularis mucosa or polyp tissue.
• Analysis of risk factors, including polyp size, resection time, and lesion type, associated with CSDP.

Main Results:

• An overall incomplete mucosal resection rate of 63% was observed.
• Incomplete resection occurred in 76% of cases with CSDP versus 57% without CSDP (P < 0.01).
• Polyp size (≥ 6mm), longer resection time (≥ 5s), and serrated lesions were identified as risk factors for CSDP.

Conclusions:

• CSDP is a significant indicator of incomplete mucosal resection during CSP.
• A substantial rate of incomplete resection exists even in the absence of CSDP, suggesting limitations of CSP for certain lesions.
• CSP may be best suited for intra-epithelial lesions, emphasizing the need for careful pre-procedure evaluation.