Related Experiment Video
Updated: Aug 6, 2026
Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Effect of external evaluation and training on the incomplete resection rate in cold snare polypectomies for colonic
Marina de Benito Sanz1,2, Jorge Feito3, Luis Hernández4
1Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain.
Background:
Cold snare polypectomy (CSP) technique for polyps <10 mm varies widely among endoscopists. This study aimed to evaluate an online educational intervention for incomplete resections.
Methods:
This multicenter trial was performed between 2021 and 2024. After a baseline assessment of incomplete resection rates for CSP of lesions <10 mm was completed, participants undertook a 1-hour online course led by an expert senior endoscopist. A second assessment was performed following course completion. Resections were evaluated using two marginal biopsies obtained after CSP, assessed by a single pathologist blinded to polyp histology. Follow-up was conducted by telephone 4 weeks after colonoscopy.
Results:
A total of 29 endoscopists participated in the baseline assessment, yielding a baseline 4.8% incomplete resection rate, with a median individual rate of 4.3% (interquartile range [IQR], 2.9%-5.7%; range, 0%-15.6%). Thirteen endoscopists completed the course and participated in the second study phase, which included 1,271 polyps in phase 1 and 826 in phase 2. No significant improvement in incomplete resection rate was observed (4.8% in phase 1 vs. 4.0% in phase 2; difference, 0.8%; 95% confidence interval [CI], -1.1% to 2.6%; p=0.4). Among 3,087 polypectomies, intraprocedural bleeding occurred in 288 (9.3%) cases; most were self-limited, with only 45 (1.5%) requiring clipping. Delayed bleeding was observed in five (0.5%) patients, four of whom had mild bleeding and one severe. No perforations were observed.
Conclusions:
The utility of online endoscopic technique courses appears limited. CSP demonstrates an excellent safety profile (ClinicalTrials.gov number: NCT04636619).
