Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm.
Background and study aimsColonic polyps > 1 cm in size are commonly managed using hot polypectomy techniques. The most frequent adverse events (delayed bleeding, post-polypectomy syndrome, and perforation) are related to electrocautery-induced injury. We hypothesized that cold resection of large polyps may have similar efficacy and improved safety compared to hot polypectomy. Our aims were to evaluate efficacy and safety of piecemeal cold snare resection of colonic polyps > 1 cm.Patients and methodsPatients undergoing lift and piecemeal cold snare polypectomy of non-pedunculated colon polyps > 1 cm from October 2013 to September 2015 were identified retrospectively. Efficacy was defined by the absence of residual adenomatous tissue at endoscopic follow-up. Adverse events (AEs), including post-procedural bleeding, bowel perforation, or post-procedural pain requiring hospitalization were assessed by chart review and telephone follow-up.ResultsSeventy-three patients underwent piecemeal cold snare polypectomy for 94 colon polyps > 1 cm with 56 of 73 patients completing follow-up on 72 polyps. Residual or recurrent adenoma was found in 7 cases (9.7 %). Median polyp size was significantly greater in those with residual/recurrent adenoma (37.1 vs. 19.1 mm,P< .0001). There were no AEs among all 73 patients enrolled.ConclusionsPiecemeal cold snare resection of colon polyps > 1 cm is feasible, safe and efficacious when compared to published hot polypectomy data. Additional observational and randomized comparative effectiveness studies are necessary to demonstrate comparable adenoma eradication and improved safety advantage over existing hot snare polypectomy techniques.
Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States.
Cyrus
C
Piraka
Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States.
Ahmed
A
Saeed
VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, United States; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, United States.
Akbar K
AK
Waljee
Division of Gastroenterology, College of Medicine, Drexel University, Philadelphia, Pennsylvania, United States.
Ajish
A
Pillai
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, United States.
Ryan
R
Stidham
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States.
B Joseph
BJ
Elmunzer