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.
