Endoscopy 2022; 54(06): 629
DOI: 10.1055/a-1823-1020
Letter to the editor

Reply to Drs. Shiha and Robinson

1   Gastroenterology Department, University Hospital “Rio Hortega”, Valladolid, Spain
1   Gastroenterology Department, University Hospital “Rio Hortega”, Valladolid, Spain
2   Servicio de Aparato Digestivo, Hospital Santos Reyes, Aranda de Duero, Spain
› Author Affiliations

We would like to thank Drs. Shiha and Robinson for their comments on our study [1], in which we observed that hot snare polypectomy (HSP) was associated with significantly higher post-procedure abdominal pain than cold snare polypectomy (CSP).

The use of submucosal injection in lesions of 3–10 mm undergoing HSP is highly variable. As a matter of fact, trials comparing HSP vs. CSP have ranged from mandatory submucosal injection to precluding it, with various trials leaving the decision to the endoscopist [2]. In the CRESCENT study, submucosal injection before HSP was performed in 43.9 % of lesions [3]. In our study design, submucosal injection before HSP was not allowed to minimize confounders.

To assess the importance of flat lesions in the abdominal pain outcomes, we performed a subgroup analysis based on the presence of flat and non-flat lesions. We observed no differences in the evolution of abdominal pain between HSP and CSP in patients presenting with flat lesions only. Unfortunately, the small sample size (13 patients in the CSP group and 19 in the HSP) prohibits conclusions being drawn from these results. Nevertheless, in patients with only sessile and pedunculated lesions, CSP presented lower rates of abdominal pain than HSP at 5 hours (4.8 % [4 /84] vs. 17.5 % [14 /80]; P = 0.01) and 24 hours after the procedure (2.4 % vs. 11.3 %; P = 0.02). Therefore, flat lesions did not skew the abdominal pain rates.

We agree CSP should be the first-line treatment in practice for lesions of 1–10 mm, but it is true that the influence of submucosal injection before HSP in the evolution of abdominal pain remains unknown. Therefore, we suggest abdominal pain should be assessed in future trials comparing resection techniques for lesions of 10–20 mm, for which both HSP with submucosal injection and HSP without submucosal injection are currently admitted alternatives.

Publication History

Article published online:
25 May 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany