Abdominal pain post-hot snare polypectomy: could it have been avoided?

We read with interest the study entitled “Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial” by de Benito Sanz et al. [1]. We congratulate the authors on this important study that adds to the body of evidence supporting the efficacy and safety of cold snare polypectomy (CSP) for small colorectal polyps. The study reported significantly higher rates of post-polypectomy abdominal pain in the hot snare polypectomy (HSP) group compared with the CSP group after 5 hours (16.5 % vs. 5.9 %; P = 0.02) and 24 hours (13.6 % vs. 3 %; P = 0.01). Moreover, HSP was the only risk factor for delayed post-polypectomy abdominal pain.

Although submucosal injection was not permitted, the study included 195 flat elevated (IIa) and 19 flat (IIb) lesions. Treating flat lesions with HSP without submucosal injection, to act as a cushion for electrocautery, is not recommended owing to the risk of deep thermal injury [2]. Therefore, we believe that patients with flat lesions treated with HSP may have experienced thermal injury that contributed to the high rates of post-polypectomy abdominal pain in the HSP group. It would be helpful if the authors could share a subgroup analysis of the rates of post-polypectomy abdominal pain according to polyp morphology (flat vs. non-flat polyps).

One previous trial investigated the rates of post-polypectomy abdominal pain 2 weeks after HSP and CSP. Only two patients (5 %) in the HSP group reported abdominal pain. Interestingly, this trial also included flat polyps without the routine use of submucosal injection [3].

Finally, we concur with the authors that CSP should be the standard technique for small colorectal polyps. However, the high rates of post-polypectomy abdominal pain in this study could have been avoided and may not reflect common clinical practice.

Publication History

Article published online:
25 May 2022

• References

• 1 de Benito Sanz M, Hernández L, Garcia Martinez MI. et al. Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy 2022; 54: 35-44
• 2 Castro R, Libânio D, Pita I. et al. Solutions for submucosal injection: What to choose and how to do it. World J Gastroenterol 2019; 25: 777-788
• 3 Ichise Y, Horiuchi A, Nakayama Y. et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion 2011; 84: 78-81