Colon polyp retrieval after cold snaring

doi:10.1016/S0016-5107(05)00376-7

Gastrointestinal Endoscopy

Volume 62, Issue 2, August 2005, Pages 253-256

https://doi.org/10.1016/S0016-5107(05)00376-7 Get rights and content

Background

The removal of small colon polyps by cold snare transection without electrocautery effectively eliminates polyps, and anecdotal reports indicate a low risk of bleeding and perforation. Concerns about using cold snaring have centered on the risk of immediate bleeding and the difficulty in retrieving the polyp. The objective was to determine the retrieval rates of polyps after cold snaring after two different methods of resection and retrieval.

Methods

Consecutive polyps were identified by a single colonoscopist who chose the technique of polypectomy (hot snare, cold snare, or cold forceps). If cold snaring was chosen, an independent observer assigned the polyp to method A (cold resection of polyp without tenting and then suction of the transected polyp into a trap) or method B (ensnare the polyp, pull it into the colonoscope channel, and then transect it while suctioning). The size and the approximate location of all polyps were recorded and all collected specimens were sent separately for histologic examination.

Results

Of 519 consecutively encountered polyps, 400 were removed by cold snare: 197 were assigned to method A and 203 to method B. The mean size of polyps that were cold snared was 3.5 mm. The mean time to remove and to retrieve polyps with method A was 14.5 seconds (n = 58) and with method B was 18.1 seconds (n = 60) (p = 0.03). There were no complications from cold snaring. The rate of successful retrieval with method A was 100% (197 of 197 polyps) and with method B was 98% (199 of 203 polyps) (p = 0.04).

Conclusions

Cold snare removal of colon polyps is associated with a high polyp retrieval rate. Each of two methods of polyp retrieval was effective. Snare transection without tenting of the polyp, followed by suctioning of the specimen off the polyp site, was more efficient, though the difference in efficiency was minimal. Difficulty or failure to retrieve polyps should not be a concern with regard to cold snare polypectomy.

Section snippets

Patients and methods

The study was approved by the Institutional Review Board at Indiana University Purdue University Indianapolis/Clarian Health Partners.

A total of 519 consecutive polyps were identified by a single experienced colonoscopist (D.K.R.), who performed polypectomy with hot snare, cold snare, or cold forceps. The study colonoscopist does not use hot forceps for polypectomy. A total of 400 polyps were selected for cold snaring, based on their size and shape. The study colonoscopist typically uses cold

Results

A total of 519 consecutive polyps in 167 patients were resected during the study interval, with 400 polyps (77%) removed by cold snare. The estimated locations and pathologic findings of the 400 polyps removed by cold snaring are shown in Table 1. Of the polyps transected by cold snare, those removed by method A had a mean size of 3.7 mm, and the polyps removed by method B had a mean size of 3.4 mm (p = 0.16). No complications were observed with cold snare transection. Of the 119 polyps removed

Discussion

In this study, we evaluated two different methods of resecting and retrieving polyps with cold snare resection. Both methods were highly effective for polyp retrieval. One method consisted of snare resection without tenting the polyp, followed by suctioning the polyp (by moving the suction channel up to the polyp as it is seen in the endoscopic field), and was a more efficient method of polypectomy. The explanation for the superiority of this method appears to be that the polyp sticks to the

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Cited by (84)

AGA Clinical Practice Update on Appropriate and Tailored Polypectomy: Expert Review
2024, Clinical Gastroenterology and Hepatology
In this Clinical Practice Update (CPU), we provide guidance on the appropriate use of different polypectomy techniques. We focus on polyps <2 cm in size that are most commonly encountered by the practicing endoscopist, including use of classification systems to characterize polyps and various polypectomy methods. We review characteristics of polyps that require complex polypectomy techniques and provide guidance on which types of polyps require more advanced management by a therapeutic endoscopist or surgeon. This CPU does not provide a detailed review of complex polypectomy techniques, such as endoscopic submucosal dissection, which should only be performed by endoscopists with advanced training.
This expert review was commissioned and approved by the American Gastroenterological Association (AGA) Institute CPU Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
A structured visual assessment using high-definition white light and/or electronic chromoendoscopy and with photodocumentation should be conducted for all polyps found during routine colonoscopy. Closely inspect colorectal polyps for features of submucosally invasive cancer.
Use cold snare polypectomy for polyps <10 mm in size. Cold forceps polypectomy can alternatively be used for 1- to 3-mm polyps where cold snare polypectomy is technically difficult.
Do not use hot forceps polypectomy.
Clinicians should be familiar with various techniques, such as cold and hot snare polypectomy and endoscopic mucosal resection, to ensure effective, safe, and optimal resection of intermediate-size polyps (10–19 mm).
Consider using lifting agents or underwater endoscopic mucosal resection for removal of sessile polyps 10–19 mm in size.
Serrated polyps should be resected using cold resection techniques. Submucosal injection may be helpful for polyps >10 mm if margins cannot be well delineated.
Use hot snare polypectomy to remove pedunculated lesions >10 mm in size.
Do not routinely use clips to close resection sites for polyps <20 mm.
Refer patients with polyps to endoscopic referral centers in the context of size ≥20 mm, challenging polypectomy location, or recurrent polyp at a prior polypectomy site.
Tattoo lesions that may need future localization at endoscopy or surgery. Tattoos should be placed in a location that will not interfere with subsequent attempts at endoscopic resection.
Refer patients with nonpedunculated polyps with clear evidence of submucosally invasive cancer for surgical evaluation.
Understand the endoscopy suite’s electrosurgical generator settings appropriate for polypectomy or postpolypectomy thermal techniques.
Serrated polyps of the colon and rectum: a concise review
2021, Revista de Gastroenterologia de Mexico
«Pólipos serrados» es el término utilizado para describir lesiones epiteliales del colon y recto que demuestran un patrón de «dientes de sierra» de la superficie y epitelio de las criptas. La llamada vía serrada describe la progresión de adenomas serrados sésiles y adenomas serrados tradicionales a cáncer colorrectal. Esta vía está bien reconocida como un mecanismo de carcinogénesis alternativo, el cual representa el 15-30% de los casos de cáncer colorrectal, explicando además una proporción significativa de los casos de cáncer colorrectal de intervalo. Por tal motivo, debido a su comportamiento incierto y usualmente agresivo, los pólipos serrados son un tema de suma relevancia en el cribado de cáncer colorrectal. Nuestro objetivo fue revisar la historia, nomenclatura actual, fisiopatología, características morfológicas, tratamiento y vigilancia de los pólipos serrados.
“Serrated polyps” is the term used for epithelial lesions of the colon and rectum that have a “sawtooth” pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps.
Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
2020, Gastroenterology
Citation Excerpt :
The total procedure time was significantly shorter using cold snare (or jumbo forceps) polypectomy compared to cold forceps techniques by an average of 2.66 minutes (95% CI, 0.18–5.14 minutes). Randomized trials of cold snare polypectomy have reported retrieval rates between 81% and 100%.67–69 Optimal methods for removal of sessile lesions measuring 10–19 mm remain uncertain.
Endoscopic Removal of Colorectal Lesions—Recommendations by the US Multi-Society Task Force on Colorectal Cancer
2020, Gastrointestinal Endoscopy
Lesion Retrieval, Specimen Handling, and Endoscopic Marking in Colonoscopy
2019, Gastrointestinal Endoscopy Clinics of North America
Colorectal polyp snaring: the smaller, the colder, the bigger!
2018, Gastrointestinal Endoscopy

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Original ArticleColon polyp retrieval after cold snaring

Background

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup

N Engl J Med

The Funen adenoma follow-up study: incidence and death from colorectal carcinoma in an adenoma surveillance program

Scand J Gastroenterol

Population-based surveillance by colonoscopy: effect of the incidence of colorectal caner

Telemark Polyp Study I. Scand J Gastroenterol

Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence

Gut

Complications of colonoscopy in a community practice setting

Gastroenterology

Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study

J Natl Cancer Inst

Endoscopic perforation of the colon: lessons from a 10-year study

Am J Gastroenterol

Diminutive colon polyps. Histopathology, spatial distribution, concomitant significant lesions, and treatment complications

Am J Gastroenterol

Cold snare excision of small colorectal polyps

Gastrointest Endosc

New methods of polypectomy

Gastrointest Endosc Clin N Am

Follow-up of hot biopsy forceps treatment of diminutive colon polyps

Gastrointest Endosc

Efficacy of hot biopsy forceps, cold micro-snare and microsnare with cautery techniques in the removal of diminutive colonic polyps

Gastrointest Endosc

The channel occlusion technique: a novel method of retrieving polyps following snare resection

Am J Gastroenterol

A double endoscope method for multiple colonic polypectomy

Gastrointest Endosc

Original Article
Colon polyp retrieval after cold snaring