Cold snare polypectomy without submucosal injection: safety and efficacy in 615 large serrated lesions

Abstract Background and study aim Cold resection is becoming the standard of care for the resection of nonpedunculated colon lesions up to 10 mm in diameter. Sessile serrated adenomas/polyps (SSA/Ps), including those ≥ 10 mm, present various characteristics that make them ideal candidates for cold snare polypectomy (CSP). Patients and methods A prospectively maintained database was searched retrospectively for consecutive patients with lesions ≥ 10 mm resected between March 2013 and March 2018. During that period, all SSA/P-appearing lesions were resected using CSP without submucosal injection, except for lesions with endoscopic suspicion of dysplasia or submucosal invasion. Patients with a pathological diagnosis of SSA/P were included in the analysis. Adverse events were recorded up to 21 days following colonoscopy. Results 615 SSA/Ps ≥ 10 mm were resected during 452 colonoscopy procedures in 379 patients (mean age 54.1 years; standard deviation [SD] 11.9 years). Mean polyp size was 13.7 (SD 5.2) mm; 122 lesions (19.8 %) were ≥ 20 mm and 479 lesions (77.9 %) underwent piecemeal resection. Immediate adverse events included persistent abdominal pain that resolved spontaneously within 2 hours in three patients (0.8 %; 95 % confidence interval [CI] 0.2 %–2.3 %). One patient with persistent intraprocedural bleeding was successfully treated with a hemostatic clip. No late adverse events were detected. Surveillance colonoscopy was performed in 293 patients (77.3 %) at 23.4 (SD 11.6) months following index colonoscopy; residual/recurrent lesions were diagnosed in 23 patients (7.8 %; 95 %CI 5.0 %–11.6 %). Conclusion CSP without submucosal injection appeared to be safe and effective for the resection of large SSA/Ps.

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Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

Endoscopy ◽

10.1055/s-0043-121219 ◽

2017 ◽

Vol 50 (03) ◽

pp. 248-252 ◽

Cited By ~ 25

Author(s):

David Tate ◽

Halim Awadie ◽

Farzan Bahin ◽

Lobke Desomer ◽

Ralph Lee ◽

...

Keyword(s):

Adverse Events ◽

Standard Of Care ◽

Wide Field ◽

High Definition ◽

Submucosal Injection ◽

Delayed Bleeding ◽

Serrated Polyps ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

Abstract Background and study aims Large series suggest endoscopic mucosal resection is safe and effective for the removal of large (≥ 10 mm) sessile serrated polyps (SSPs), but it exposes the patient to the risks of electrocautery, including delayed bleeding. We examined the feasibility and safety of piecemeal cold snare polypectomy (pCSP) for the resection of large SSPs. Methods Sequential large SSPs (10 – 35 mm) without endoscopic evidence of dysplasia referred over 12 months to a tertiary endoscopy center were considered for pCSP. A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months. Results 41 SSPs were completely removed by pCSP in 34 patients. The median SSP size was 15 mm (interquartile range [IQR] 14.5 – 20 mm; range 10 – 35 mm). The median procedure duration was 4.5 minutes (IQR 1.4 – 6.3 minutes). There was no evidence of perforation or significant intraprocedural bleeding. At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. First follow-up has been undertaken for 15 /41 lesions at a median of 6 months with no evidence of recurrence. Conclusions There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding.

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Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods

Gut ◽

10.1136/gutjnl-2020-321753 ◽

2020 ◽

pp. gutjnl-2020-321753

Author(s):

W Arnout van Hattem ◽

Neal Shahidi ◽

Sergei Vosko ◽

Imogen Hartley ◽

Kaushali Britto ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Mucosal Resection ◽

Standard Of Care ◽

Technical Success ◽

Delayed Bleeding ◽

Historical Comparison ◽

Mucosal Resection ◽

Cold Snare Polypectomy ◽

Serrated Lesions ◽

Snare Polypectomy

ObjectiveLarge (≥20 mm) sessile serrated lesions (L-SSL) are premalignant lesions that require endoscopic removal. Endoscopic mucosal resection (EMR) is the existing standard of care but carries some risk of adverse events including clinically significant post-EMR bleeding and deep mural injury (DMI). The respective risk-effectiveness ratio of piecemeal cold snare polypectomy (p-CSP) in L-SSL management is not fully known.DesignConsecutive patients referred for L-SSL management were treated by p-CSP from April 2016 to January 2020 or by conventional EMR in the preceding period between July 2008 and March 2016 at four Australian tertiary centres. Surveillance colonoscopies were conducted at 6 months (SC1) and 18 months (SC2). Outcomes on technical success, adverse events and recurrence were documented prospectively and then compared retrospectively between the subsequent time periods.ResultsA total of 562 L-SSL in 474 patients were evaluated of which 156 L-SSL in 121 patients were treated by p-CSP and 406 L-SSL in 353 patients by EMR. Technical success was equal in both periods (100.0% (n=156) vs 99.0% (n=402)). No adverse events occurred in p-CSP, whereas delayed bleeding and DMI were encountered in 5.1% (n=18) and 3.4% (n=12) of L-SSL treated by EMR, respectively. Recurrence rates following p-CSP were similar to EMR at 4.3% (n=4) versus 4.6% (n=14) and 2.0% (n=1) versus 1.2% (n=3) for surveillance colonoscopy (SC)1 and SC2, respectively.ConclusionsIn a historical comparison on the endoscopic management of L-SSL, p-CSP is technically equally efficacious to EMR but virtually eliminates the risk of delayed bleeding and perforation. p-CSP should therefore be considered as the new standard of care for L-SSL treatment.

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Safety and efficacy of cold snare polypectomy without submucosal injection for large sessile serrated lesions: a prospective study

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2020.10.053 ◽

2020 ◽

Author(s):

Yoshiaki Kimoto ◽

Eiji Sakai ◽

Rin Inamoto ◽

Marie Kurebayashi ◽

Syunya Takayanagi ◽

...

Keyword(s):

Prospective Study ◽

Safety And Efficacy ◽

Submucosal Injection ◽

Cold Snare Polypectomy ◽

Serrated Lesions ◽

A Prospective Study ◽

Snare Polypectomy

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

Endoscopy International Open ◽

10.1055/s-0043-101696 ◽

2017 ◽

Vol 05 (03) ◽

pp. E184-E189 ◽

Cited By ~ 35

Author(s):

Cyrus Piraka ◽

Ahmed Saeed ◽

Akbar Waljee ◽

Ajish Pillai ◽

Ryan Stidham ◽

...

Keyword(s):

Adverse Events ◽

Bowel Perforation ◽

Colonic Polyps ◽

Similar Efficacy ◽

Colon Polyps ◽

Polyp Size ◽

Delayed Bleeding ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

Abstract Background and study aims Colonic polyps > 1 cm in size are commonly managed using hot polypectomy techniques. The most frequent adverse events (delayed bleeding, post-polypectomy syndrome, and perforation) are related to electrocautery-induced injury. We hypothesized that cold resection of large polyps may have similar efficacy and improved safety compared to hot polypectomy. Our aims were to evaluate efficacy and safety of piecemeal cold snare resection of colonic polyps > 1 cm. Patients and methods Patients undergoing lift and piecemeal cold snare polypectomy of non-pedunculated colon polyps > 1 cm from October 2013 to September 2015 were identified retrospectively. Efficacy was defined by the absence of residual adenomatous tissue at endoscopic follow-up. Adverse events (AEs), including post-procedural bleeding, bowel perforation, or post-procedural pain requiring hospitalization were assessed by chart review and telephone follow-up. Results Seventy-three patients underwent piecemeal cold snare polypectomy for 94 colon polyps > 1 cm with 56 of 73 patients completing follow-up on 72 polyps. Residual or recurrent adenoma was found in 7 cases (9.7 %). Median polyp size was significantly greater in those with residual/recurrent adenoma (37.1 vs. 19.1 mm, P < .0001). There were no AEs among all 73 patients enrolled. Conclusions Piecemeal cold snare resection of colon polyps > 1 cm is feasible, safe and efficacious when compared to published hot polypectomy data. Additional observational and randomized comparative effectiveness studies are necessary to demonstrate comparable adenoma eradication and improved safety advantage over existing hot snare polypectomy techniques.

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Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

10.26226/morressier.59a6b347d462b80290b54bac ◽

2017 ◽

Author(s):

David Tate

Keyword(s):

Wide Field ◽

Submucosal Injection ◽

Serrated Polyps ◽

Cold Snare Polypectomy ◽

Snare Polypectomy

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Cold snare polypectomy for large sessile serrated lesions is safe but follow-up is needed: A single-centre retrospective study

United European Gastroenterology Journal ◽

10.1177/2050640620964641 ◽

2020 ◽

pp. 205064062096464

Author(s):

Naohisa Yoshida ◽

Ken Inoue ◽

Yuri Tomita ◽

Hikaru Hashimoto ◽

Satoshi Sugino ◽

...

Keyword(s):

Risk Factors ◽

En Bloc Resection ◽

Bloc Resection ◽

Histopathological Diagnosis ◽

Single Centre ◽

En Bloc ◽

Cold Snare Polypectomy ◽

Serrated Lesions ◽

Snare Polypectomy

Background and aim Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. Methods This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10–20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10–14 mm in size to those for lesions 15–20 mm in size. Results We analysed 160 lesions in 100 patients ( Mage± SD=67.7±10.1 years). The polyp size ( M± SD) was 11.8±2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12–24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10–14 mm in size and 15–20 mm in size were 4.7% and 6.3%, respectively ( p=0.713). Conclusion CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.

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V.02.7 CASE REPORT: COLD SNARE POLYPECTOMY OF SERRATED ADENOMAS UNDER ARTIFICIAL INTELLIGENCE GUIDANCE

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30906-3 ◽

2020 ◽

Vol 52 ◽

pp. S185-S186

Author(s):

M. Badalamenti ◽

G. Pellegatta ◽

R. Maselli ◽

E.C. Ferrara ◽

A. Fugazza ◽

...

Keyword(s):

Artificial Intelligence ◽

Case Report ◽

Cold Snare Polypectomy ◽

Snare Polypectomy ◽

Serrated Adenomas

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Safety of Endoscopic Mucosal Resection Using a Bipolar Snare for Superficial Nonampullary Duodenal Epithelial Tumors and the Predictive Factors of Piecemeal Resection

Digestion ◽

10.1159/000510601 ◽

2020 ◽

pp. 1-9

Author(s):

Masafumi Yamamura ◽

Yasuaki Nagami ◽

Taishi Sakai ◽

Hirotsugu Maruyama ◽

Masaki Ominami ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Mucosal Resection ◽

R0 Resection ◽

En Bloc ◽

Noninvasive Treatment ◽

Submucosal Injection ◽

Mucosal Resection ◽

Epithelial Tumors ◽

Bipolar Snare ◽

Piecemeal Resection

Introduction: Endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors is a noninvasive treatment; however, perforations can occur. Bipolar snares can reduce the risk of perforation due to small tissue damage. Currently, only few studies have reported endoscopic mucosal resection for small superficial nonampullary duodenal epithelial tumors using a bipolar snare and the effect of preoperative findings. Objective: To investigate (1) resectability and adverse events of endoscopic mucosal resection using a bipolar snare for small superficial nonampullary duodenal epithelial tumors and (2) the predictions of piecemeal resection. Methods: Between 2007 and 2017, 89 patients with 107 lesions underwent endoscopic mucosal resection using a bipolar snare. Among them, 88 lesions of 77 patients were evaluated. The primary outcome was the incidence of en bloc resection and R0 resection and adverse events. Risk factors associated with piecemeal resection, including preoperative lesion findings, were also examined. Results: The incidence rates of en bloc and R0 resections were 85.2 and 48.9%, respectively. Neither intraoperative or delayed perforations nor procedure-related mortality was noted. The nonlifting sign after submucosal injection was associated with an increase in piecemeal resection (odds ratio: 20.3, 95% confidence interval: 2.53–162; p = 0.005). Conclusion: Endoscopic resection for small superficial nonampullary duodenal epithelial tumors can cause perforation; however, endoscopic mucosal resection using a bipolar snare can be a safe treatment option as it does not cause perforations. The nonlifting sign after submucosal injection is a predictive factor for piecemeal resection.

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