Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for nonpedunculated colorectal polyps of 10-19 mm: a multicenter observational cohort study

Dileep Mangira; Spiro Raftopoulos; Sara Vogrin; Imogen Hartley; Alexandra Mack; Kathryn Gazelakis; Kumanan Nalankilli; Andrew Trinh; Andrew J. Metz; Mark Appleyard; Florian Grimpen; Timothy Elliott; Gregor Brown; Alan Moss

doi:10.1055/a-2029-9539

Endoscopy, Table of Contents

Endoscopy 2023; 55(07): 627-635
DOI: 10.1055/a-2029-9539

Original article

Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for nonpedunculated colorectal polyps of 10-19 mm: a multicenter observational cohort study

Authors

Dileep Mangira

¹Department of Gastroenterology, Western Health, Melbourne, Australia

²Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Australia
Spiro Raftopoulos

³Department of Gastroenterology, Peel Health Campus, Perth, Australia
Sara Vogrin

²Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Australia

⁴Australian Institute for Musculoskeletal Science, Melbourne, Australia
Imogen Hartley

¹Department of Gastroenterology, Western Health, Melbourne, Australia
Alexandra Mack

¹Department of Gastroenterology, Western Health, Melbourne, Australia
Kathryn Gazelakis

¹Department of Gastroenterology, Western Health, Melbourne, Australia
Kumanan Nalankilli

¹Department of Gastroenterology, Western Health, Melbourne, Australia
Andrew Trinh

⁵Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
Andrew J. Metz

⁵Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
Mark Appleyard

⁶Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Australia
Florian Grimpen

⁶Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Australia
Timothy Elliott

⁷Department of Internal Medicine, Ballarat Base Hospital, Ballarat, Australia
Gregor Brown

⁸Department of Gastroenterology, The Alfred, Melbourne, Australia
Alan Moss

¹Department of Gastroenterology, Western Health, Melbourne, Australia

²Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Australia

Abstract

Background Cold snare polypectomy (CSP) is the standard of care for the resection of small (< 10 mm) colonic polyps. Limited data exist for its efficacy for medium-sized (10–19 mm) nonpedunculated polyps, especially conventional adenomas. This study evaluated the effectiveness and safety of CSP/cold endoscopic mucosal resection (C-EMR) for medium-sized nonpedunculated colonic polyps.

Methods A prospective multicenter observational study was conducted of all morphologically suitable nonpedunculated colonic polyps of 10–19 mm removed by CSP/C-EMR between May 2018 and June 2021. Once resection was complete, multiple biopsies were taken of the margins circumferentially and centrally. The primary outcome was the incomplete resection rate (IRR), based on residual polyp in these biopsy specimens. Secondary outcomes were recurrence rate at first surveillance colonoscopy and rates of adverse events (AEs).

Results CSP/C-EMR was performed for 350 polyps (median size 15 mm; 266 [76.0 %] Paris 0-IIa classification) in 295 patients. Submucosal injection was used for 87.1 % (n = 305) of polyps. Histology showed 68.6 % adenomas, 26.0 % sessile serrated lesions (SSLs) without dysplasia, 4.0 % SSL with dysplasia, and 1.4 % hyperplastic polyps. The IRRs based on margin or central biopsies being positive were 1.7 % (n = 6) and 0.3 % (n = 1), respectively. The polyp recurrence rate was 1.7 % (n = 4) at first surveillance colonoscopy – completed for 65.4 % (n = 229) of polyps at a median interval of 9.7 months. AEs occurred in 3.4 % (n = 10) of patients: four with post-polypectomy pain; three self-limiting post-polypectomy bleeds; two post-polypectomy-syndrome-like presentations; and one intraprocedural bleed treated with clips. There were no perforations.

Conclusion CSP/C-EMR for morphologically suitable nonpedunculated colonic polyps of 10–19 mm is effective and safe, including for conventional adenomas. Rates of incomplete resection and recurrence were low, with few AEs. Studies directly comparing this method with hot snare resection are required.

Full Text

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