Cold Snare Polypectomy for Small Pedunculated Polyps: Next Step in the Cold Revolution?
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EDITORIAL
Cold Snare Polypectomy for Small Pedunculated Polyps: Next Step in the Cold Revolution? Hein Htet1 · Pete Basford1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
In recent years cold snare polypectomy (CSP) for resection of colorectal polyps during colonoscopy has grown in popularity worldwide. CSP has been shown to be superior to cold biopsy for removal of diminutive polyps, and it is quicker and avoids the risk of deep thermal injury, associated with the use of diathermy current during hot snare polypectomy (HSP). Several studies have demonstrated that CSP is equivalent to HSP in achieving complete resection of colorectal polyps up to 9 mm in size [1–3]. The rate of immediate bleeding has been shown to be higher with CSP compared to HSP, but this is rarely clinically significant and can be managed with simple hemostatic measures during the procedure if needed [2, 3]. Thus, European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of CSP for removal of polyps ≤ 9 mm [4]. Piecemeal cold snare endoscopic mucosal resection has also been shown to be an effective treatment for larger sessile serrated lesions [5]. However, to date, most studies examining the safety and efficacy of CSP have included only sessile or flat-elevated polyps. Pedunculated polyps are traditionally felt to have an increased risk of post-polypectomy bleeding due to the presence a dominant feeding blood vessel in the stalk, and hence, HSP is recommended to ensure cauterization of the vessel. The morphology of pedunculated polyps allows placement of the snare away from the colonic wall to minimize the risk of deep thermal injury. Therefore, ESGE recommends the use of HSP in pedunculated polyps(3). However, there is a paucity of literature on the choice of polypectomy technique in small and low-risk pedunculated polyps. This traditional view of pedunculated polyps carrying increased bleeding risk was not supported by the findings of a very large study of polyps removed in the UK bowel cancer screening * Pete Basford [email protected] 1
Department of Gastroenterology, St Richard’s Hospital, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
program which found size to be the only significant risk factor [6]. In this issue of Digestive Diseases and Sciences, Arimoto et al. report the findings of a large retrospective study comparing CSP with HSP in pedunculated polyps of 2.6 mm means that the findings apply to a relatively small proportion of colonic lesions, and pedunculated polyps with thicker stalks may
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Digestive Diseases and Sciences
still require the use of diathermy to allow resection, irrespective of any bleeding risk. Arimoto et al. have demonstrated some evidence of the safety and efficacy of CSP in small pedunculated polyps, including some patients taking anticoagulation. The use of CSP for removal of small pedunculated polyps may become a further step in the cold revolution.
References 1. Papastergiou V, Paraskeva KD, Fragaki M, et al. Cold versus hot endoscopic m
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