Endoscopy 2018; 50(03): 248-252
DOI: 10.1055/s-0043-121219
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe

David J. Tate
Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Halim Awadie
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Farzan F. Bahin
Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Lobke Desomer
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Ralph Lee
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Steven J. Heitman
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Kathleen Goodrick
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
,
Michael J. Bourke
Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

submitted 26 March 2017

accepted after revision 14 September 2017

Publication Date:
23 November 2017 (eFirst)

Abstract

Background and study aims Large series suggest endoscopic mucosal resection is safe and effective for the removal of large (≥ 10 mm) sessile serrated polyps (SSPs), but it exposes the patient to the risks of electrocautery, including delayed bleeding. We examined the feasibility and safety of piecemeal cold snare polypectomy (pCSP) for the resection of large SSPs.

Methods Sequential large SSPs (10 – 35 mm) without endoscopic evidence of dysplasia referred over 12 months to a tertiary endoscopy center were considered for pCSP. A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months.

Results 41 SSPs were completely removed by pCSP in 34 patients. The median SSP size was 15 mm (interquartile range [IQR] 14.5 – 20 mm; range 10 – 35 mm). The median procedure duration was 4.5 minutes (IQR 1.4 – 6.3 minutes). There was no evidence of perforation or significant intraprocedural bleeding. At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. First follow-up has been undertaken for 15 /41 lesions at a median of 6 months with no evidence of recurrence.

Conclusions There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding.