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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(06): E791-E800
DOI: 10.1055/a-1784-4523
Original article

Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions

Andrew W. Yen
1   Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States
2   University of California Davis School of Medicine, Sacramento, California, United States
,
Joseph W. Leung
1   Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, Mather, California, United States
2   University of California Davis School of Medicine, Sacramento, California, United States
,
Malcom Koo
3   Graduate Institution of Long-term Care, Tzu Chi University of Science and Technology, Hualien City, Hualien, Taiwan
4   Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
,
Felix W. Leung
5   Sepulveda Ambulatory Care Center, VAGLAHS, Division of Gastroenterology, North Hills, California, United States
6   David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Comment on:

Endoscopy International Open – recently publishedEndoscopy 2022; 54(07): 731-731
DOI: 10.1055/a-1776-4179

Abstract

Background and study aims Adverse events are uncommon with cold snaring, but cold techniques are generally reserved for lesions ≤ 9 mm out of concern for incomplete resection or inability to mechanically resect larger lesions. In a non-distended, water-filled lumen, colorectal lesions are not stretched, enabling capture and en bloc resection of large lesions. We assessed the effectiveness and safety of underwater cold snare resection (UCSR) without submucosal injection (SI) of ≥ 10 mm non-pedunculated, non-bulky (≤ 5 mm elevation) lesions with small, thin wire snares.

Patients and methods Retrospective analysis of an observational cohort of lesions removed by UCSR during colonoscopy. A single endoscopist performed procedures using a small thin wire (9-mm diameter) cold or (10-mm diameter) hybrid snare.

Results Fifty-three lesions (mean 15.8 mm [SD 6.9]; range 10–35 mm) were removed by UCSR from 44 patients. Compared to a historical cohort, significantly more lesions were resected en bloc by UCSR (84.9 % [45/53]; P = 0.04) compared to conventional endoscopic mucosal resection (EMR) (64.0 % [32/50]). Results were driven by high en bloc resection rates for 10– to 19-mm lesions (97.3 % [36/37]; P = 0.01). Multiple logistic regression analysis adjusted for potential confounders showed en bloc resection was significantly associated with UCSR compared to conventional EMR (OR 3.47, P = 0.027). Omission of SI and forgoing prophylactic clipping of post-resection sites did not result in adverse outcomes.

Conclusions UCSR of ≥ 10 mm non-pedunculated, non-bulky colorectal lesions is feasible with high en bloc resection rates without adverse outcomes. Omission of SI and prophylactic clipping decreased resource utilization with economic benefits. UCSR deserves further evaluation in a prospective comparative study.



Publication History

Received: 15 September 2021

Accepted after revision: 29 November 2021

Article published online:
10 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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