Cold snare polypectomy of large lesions: One swallow does not a summer make

In this issue of Endoscopy, Tate et al. [1] report on the safety of piecemeal cold snare polypectomy (pCSP) of 41 sessile serrated polyps (SSPs) ≥ 10 mm in the colon. CSP is nowadays the preferred technique for removal of diminutive polyps as it safe, very effective, fast, and allows proper histological assessment. Although at first it was reserved for polyps of < 5 mm, recent papers support the use of CSP for small polyps up to 10 mm. The idea of expanding the limits of CSP to polyps ≥ 10 mm, as examined by Tate et al., is attractive because post-polypectomy complications, including delayed bleeding, post-polypectomy syndrome, and perforation, are thought to be associated with thermal injury to either submucosal vessels or the muscle layer.

• References

• 1 Tate DJ, Awadie H, Bahin FF. et al. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe. Endoscopy 2017; 50: 248-252
• 2 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
• 3 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 DOI: 10.1136/gutjnl-2017-314215.
• 4 Papastergiou V, Paraskeva KD, Fragaki M. et al. Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial. Endoscopy DOI: 10.1055/s-0043-118594.
• 5 Barros RA, Monteverde MJ, Barros RF. et al. Cold snare resection of a nonpolypoid lesion >45 mm. Gastrointest Endosc 2014; 80: 1176-1177
• 6 Tutticci NJ, Hewett DG. Cold endoscopic mucosal resection of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc DOI: 10.1016/j.gie.2017.11.002.
• 7 Piraka C, Saeed A, Waljee AK. et al. Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. Endosc Int Open 2017; 5: E184-E189
• 8 Muniraj T, Sahakian A, Ciarleglio MM. et al. Cold snare polypectomy for large sessile colonic polyps: a single-center experience. Gastroenterol Res Pract 2015 2015; 175959
• 9 Augusto Barros R, Monteverde MJ, Federico Barros R. et al. [Safety and efficacy of cold snare resection of non-polypoid colorectal lesions (0-IIa and 0-IIb)]. Acta Gastroenterol Latinoam 2014; 44: 27-32
• 10 Pellise M, Burgess NG, Tutticci N. et al. Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions. Gut 2017; 66: 644-653
• 11 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
• 12 Horiuchi A, Makino T, Kajiyama M. et al. Comparison between endoscopic mucosal resection and hot snare resection of large nonpedunculated colorectal polyps: a randomized trial. Endoscopy 2016; 48: 646-651