Identifying the impossible: piecemeal cold snare resection perforation.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Piecemeal cold snare resection (CSR) is a common technique for large nonpedunculated colorectal polyps.
• While generally safe, CSR carries a rare risk of perforation.
• This case highlights an intraprocedural perforation during CSR.

Purpose of the Study:

• To report a rare case of intraprocedural perforation during piecemeal cold snare resection (CSR).
• To emphasize the importance of thorough resection base assessment in CSR procedures.

Main Methods:

• A 63-year-old woman with Crohn disease underwent surveillance for colorectal polyps.
• Piecemeal CSR was performed on two large 0-IIA transverse colon polyps using a 10-mm cold snare and chromoinjectate.
• Submucosal chromoendoscopy identified a deep mural injury, which was managed with through-the-scope clips.

Main Results:

• A type IV deep mural injury was identified during piecemeal CSR, despite the absence of electrocautery.
• The injury was successfully managed with endoscopic clipping.
• The patient recovered without delayed adverse events.

Conclusions:

• Perforation is a rare but possible complication of piecemeal cold snare resection (CSR).
• Endoscopists must conduct meticulous resection base assessments, as the lack of cautery can mask deep mural injuries.
• Early recognition and endoscopic management are key to favorable outcomes.