title: Cold snare polypectomy: does snare type influence outcomes?
abstract: OBJECTIVE
  Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown.
  
  
  METHODS
  Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation.
  
  
  RESULTS
  One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare.
  
  
  CONCLUSIONS
  Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique.
authors: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.|Department of Oncology, University of Sheffield, Medical School, Sheffield, UK.
authors: Said
authors: S
authors: Din
authors: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.|Department of Oncology, University of Sheffield, Medical School, Sheffield, UK.
authors: Alex J
authors: AJ
authors: Ball
authors: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors: Stuart A
authors: SA
authors: Riley
authors: Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK.
authors: Panagiota
authors: P
authors: Kitsanta
authors: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors: Shawinder
authors: S
authors: Johal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: cold snare; efficacy; polypectomy; small polyp; snare type