Endoscopy 2024; 56(02): 102-107
DOI: 10.1055/a-2189-2679
Original article

One-device colonoscopy: feasibility, cost savings, and plastic waste reduction by procedure indication, when performed by a high detecting colonoscopist

Douglas K. Rex
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)
Jackson A. Gallagher
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)
Rachel E. Lahr
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)
Krishna C. Vemulapalli
1   Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, United States (Ringgold ID: RIN12250)
Prateek Sharma
2   Division of Gastroenterology, Hepatology and Motility, University of Kansas School of Medicine, Kansas City, United States (Ringgold ID: RIN12251)
3   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, United States (Ringgold ID: RIN20044)
Cesare Hassan
4   Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)
5   Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
› Author Affiliations


Background Cold forceps and snares are each effective for removing polyps of 1–3 mm, while snares are more effective for polyps of 4–10 mm in size. If, in the same patient, polyps of 1–3 mm are removed with forceps and those of 4–10 mm with snares, two devices are used. If cold snares are used to resect all lesions of 1–10 mm (one-device colonoscopy), there is a potential for lower costs and less plastic waste.

Methods A single high detecting colonoscopist prospectively measured the feasibility of cold snaring all colorectal lesions of ≤10 mm in size, along with the associated costs and plastic waste reduction.

Results 677 consecutive lower gastrointestinal endoscopies (not for inflammatory bowel disease) were assessed. Of 1430 lesions of 1–3 mm and 1685 lesions of 4–10 mm in size, 1428 (99.9%, 95%CI 99.5%–100%) and 1674 (99.3%, 95%CI 98.8%–99.7%), respectively, were successfully resected using cold snaring. Among 379 screening and surveillance patients, universal cold snaring of lesions ≤10 mm saved 35 and 47 cold forceps per 100 screening and surveillance patients, respectively.

Conclusion Cold snare resection of all lesions ≤10 mm (one-device colonoscopy) was feasible, and reduced costs and plastic waste.

Publication History

Received: 13 July 2023

Accepted after revision: 10 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Sebastian S, Dhar A, Baddeley R. et al. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72: 12-26 DOI: 10.1136/gutjnl-2022-328460. (PMID: 36229172)
  • 2 Pohl H, de Latour R, Reuben A. et al. GI multisociety strategic plan on environmental sustainability. Gastrointest Endosc 2022; 96: 881-886 e2 DOI: 10.1053/j.gastro.2022.09.029. (PMID: 36270827)
  • 3 Wei MT, Louie CY, Chen Y. et al. Randomized controlled trial investigating cold snare and forceps polypectomy among small POLYPs in rates of complete resection: the TINYPOLYP Trial. Am J Gastroenterol 2022; 117: 1305-1310
  • 4 Kamal F, Khan MA, Lee-Smith W. et al. Cold snare versus cold forceps polypectomy for endoscopic resection of diminutive polyps: meta-analysis of randomized controlled trials. Gastrointest Endosc 2023; 98: 7-18.e4
  • 5 Rex DK, Anderson JC, Pohl H. et al. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022; 96: 330-338 DOI: 10.1016/j.gie.2022.03.006. (PMID: 35288147)
  • 6 Mangira D, Raftopoulos S, Vogrin S. et al. Effectiveness and safety of cold snare polypectomy and cold endoscopic mucosal resection for non-pedunculated colorectal polyps of 10–19 mm: a multicenter observational cohort study. Endoscopy 2023; 55: 627-635
  • 7 El Rahyel A, Abdullah N, Love E. et al. Recurrence after endoscopic mucosal resection: early and late incidence, treatment outcomes, and outcomes in non-overt (histologic-only) recurrence. Gastroenterology 2021; 160: 949-951 e2 DOI: 10.1053/j.gastro.2020.10.039. (PMID: 33130101)
  • 8 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607 e1 DOI: 10.1053/j.gastro.2012.05.006. (PMID: 22609383)
  • 9 Fatima H, Tariq T, Gilmore A. et al. Bleeding risk with cold snare polypectomy of ≤10 mm pedunculated colon polyps. J Clin Gastroenterol 2023; 57: 294-299
  • 10 Thoguluva Chandrasekar V, Spadaccini M, Aziz M. et al. Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis. Gastrointest Endosc 2019; 89: 929-936 e3
  • 11 Kawamura T, Takeuchi Y, Asai S. et al. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 2018; 67: 1950-1957 DOI: 10.1136/gutjnl-2017-314215. (PMID: 28970290)
  • 12 Jegadeesan R, Aziz M, Desai M. et al. Hot snare vs. cold snare polypectomy for endoscopic removal of 4–10mm colorectal polyps during colonoscopy: a systematic review and meta-analysis of randomized controlled studies. Endosc Int Open 2019; 7: E708-E716
  • 13 Chang LC, Chang CY, Chen CY. et al. Cold versus hot snare polypectomy for small colorectal polyps: a pragmatic randomized controlled trial. Ann Intern Med 2023; 176: 311-319 DOI: 10.7326/M22-2189. (PMID: 36802753)
  • 14 Ito A, Suga T, Ota H. et al. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 2018; 53: 1171-1178 DOI: 10.1007/s00535-018-1446-2. (PMID: 29516270)
  • 15 Toyosawa J, Yamasaki Y, Fujimoto T. et al. Resection depth for small colorectal polyps comparing cold snare polypectomy, hot snare polypectomy and underwater endoscopic mucosal resection. Endosc Int Open 2022; 10 (05) E602-E608 DOI: 10.1055/a-1785-8616. (PMID: 35571476)
  • 16 Suzuki S, Gotoda T, Kusano C. et al. Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc 2018; 87: 1095-1103 DOI: 10.1016/j.gie.2017.10.041. (PMID: 29122600)
  • 17 Ponugoti PL, Cummings OW, Rex DK. Risk of cancer in small and diminutive colorectal polyps. Dig Liver Dis 2017; 49: 34-37 DOI: 10.1016/j.dld.2016.06.025. (PMID: 27443490)
  • 18 Ponugoti P, Rastogi A, Kaltenbach T. et al. Disagreement between high confidence endoscopic adenoma prediction and histopathological diagnosis in colonic lesions ≤3 mm in size. Endoscopy 2019; 51: 221-226
  • 19 Ahmad A, Moorghen M, Wilson A. et al. Implementation of optical diagnosis with a "resect and discard" strategy in clinical practice: DISCARD3 study. Gastrointest Endosc 2022; 96: 1021-1032 e2
  • 20 Joao M, Areia M, Pinto-Pais T. et al. Can white-light endoscopy or narrow-band imaging avoid biopsy of colorectal endoscopic mucosal resection scars? A multicenter randomized single-blind crossover trial. Endoscopy 2023; 55: 601-607 DOI: 10.1055/a-2018-1612. (PMID: 36690030)