title: Cold snare piecemeal resection of colonic and duodenal polyps ≥1 cm.
abstract: BACKGROUND
  Endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma. The use of cautery carries a risk of delayed bleeding, post-polypectomy syndrome, and perforation. We examined the safety and feasibility of removing colonic and duodenal polyps ≥ 1 cm using a piecemeal cold snare polypectomy technique.
  
  
  METHODS
  The study included 15 patients with duodenal polyps ≥ 1 cm and 15 patients with colonic polyps ≥ 1 cm.
  
  
  METHODS
  Bleeding, perforation, abdominal pain, or hospitalization occurring within 2 weeks of polypectomy.
  
  
  RESULTS
  Between 24 August 2011 and 29 April 2013, 15 patients had removal of duodenal polyps ≥ 1 cm. Mean patient age was 64 years and 9/15 patients were male. The mean polyp size was 24 mm (10 - 60 mm). All polyps were removed with a cold snare and some required cold biopsy forceps. One patient required hospitalization for gastrointestinal blood loss 7 days post-polypectomy; this patient was using Coumadin. Between 27 February 2012 and 30 May 2013, 15 patients underwent resection of a ≥ 1 cm colonic polyp. Mean patient age was 68 years and 9/15 were male. The mean polyp size was 20 mm (10 - 45 mm). All polyps were primarily removed with a cold snare. None of the patients required hemostatic clips for control of immediate bleeding. One patient presented to the emergency department with abdominal pain 1 day after initial endoscopy. CT scan showed no abnormalities and the patient was discharged.
  
  
  CONCLUSIONS
  Cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery-based endoscopic resection. Comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods.
authors.affiliation: Division of Gastroenterology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Choksi
authors.affiliation: Division of Gastroenterology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.affiliation: Division of Gastroenterology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Stidham
authors.affiliation: Division of Gastroenterology, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shuster
authors.affiliation: Division of Gastroenterology, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Piraka