title: Characterization and significance of protrusions in the mucosal defect after cold snare polypectomy.
abstract: BACKGROUND
  Cold snare polypectomy (CSP) is widely practiced; however, the endoscopic features of the CSP mucosal defect have not been studied. In particular, protrusions within the cold snare defect (CSDPs) may create concern for residual polyp. The frequency and constituents of this phenomenon are unknown.
  
  
  OBJECTIVE
  To describe the frequency, predictors, and histologic constituents of CSDPs.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary-care hospital endoscopy unit.
  
  
  METHODS
  Eighty-eight consecutive patients undergoing CSP for a polyp ≤ 10 mm in size.
  
  
  METHODS
  Inspection of the cold snare mucosal defect with high-definition white light and biopsy sampling of CSDPs for separate histologic assessment, when present.
  
  
  METHODS
  Frequency and constituents of CSDPs.
  
  
  RESULTS
  Two hundred fifty-seven consecutive polyps ≤ 10 mm in size were removed in 88 patients (50 men [57%], mean age 63 years). Polyps were predominately adenomatous (162, 63%), located in the proximal colon (159, 62%) and flat (200, 78%). Mean lesion size was 5.5 mm (range, 2-10 mm). High-grade dysplasia was present in a single polyp for which the defect was bland. CSDPs occurred in 36 polypectomies (14%). CSDPs were associated with polyp size ≥ 6 mm (odds ratio, 3.7; P < .001 multivariable analysis) but not age, sex, lesion, histopathology, morphology, or location. Histopathologic examination of CSDPs revealed submucosa in 34 (94%) and muscularis mucosa in 29 (80%). No residual adenomatous or serrated polyp tissue was detected.
  
  
  CONCLUSIONS
  Single-center study. Small number of polyps with high-grade dysplasia.
  
  
  CONCLUSIONS
  Protrusions are common within the CSP mucosal defect and are associated with polyp size ≥ 6 mm. CSDPs do not represent vascular structures, do not contain residual polyp, and are not associated with adverse outcomes in short-term follow-up. However, CSDPs represent incomplete mucosal layer resection.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tutticci
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Burgess
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Maria
authors.initials: M
authors.lastname: Pellise
authors.affiliation: Department of Anatomical Pathology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: Mcleod
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D047368:Tumor Burden