title: A randomized comparison of cold snare polypectomy versus a suction pseudopolyp technique.
abstract: BACKGROUND
  Cold snare techniques are widely used for removal of diminutive and small colorectal polyps. The influence of resection technique on the effectiveness of polypectomy is unknown. We therefore compared standard cold snare polypectomy with a newly described suction pseudopolyp technique, for completeness of excision and for complications.
  
  
  METHODS
  In this single-center study, 112 patients were randomized to cold snare polypectomy or the suction pseudopolyp technique. Primary outcome was endoscopic completeness of excision. Consensus regarding the endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp "fly away" and retrieval rates, early bleeding (48 hours), delayed bleeding (2 weeks), and perforation.
  
  
  RESULTS
  148 polyps were removed, with size range 3 - 7 mm, 60 % in the left colon, and 90 % being sessile. Regarding completeness of excision (with uncertain findings omitted): endoscopically, this was higher with the suction pseudopolyp technique compared with cold snare polypectomy but not statistically significantly so (73/74 [98.6 %] vs. 63/68 [92.6 %]; P = 0.08). A trend towards a higher complete histological excision rate with the suction pseudopolyp technique was also not statistically significant (45/59 [76.3 %] vs. 37/58 [63.8 %]; P = 0.14). Polyp retrieval rate was not significantly different (suction 68/76 [89.5 %] vs. cold snare 64/72 [88.9 %]; P = 0.91). No perforation or bleeding requiring hemostasis occurred in either group.
  
  
  CONCLUSIONS
  In this study both polypectomy techniques were found to be safe and highly effective, but further large multicenter trials are required.Clinical trial registration at www.clinicaltrials.gov: NCT02208401.
authors.affiliation: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Said
authors.initials: S
authors.lastname: Din
authors.affiliation: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Ball
authors.affiliation: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Riley
authors.affiliation: Department of Histopathology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Kitsanta
authors.affiliation: Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Shawinder
authors.initials: S
authors.lastname: Johal
mesh_terms: D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D013396:Suction; D016896:Treatment Outcome