A concern about generating solid waste from cold snare polypectomy

Abstract

I read with interest the March 2021 Gastrointestinal Endoscopy article by McWhinney et al,1McWhinney C.D. Vemulapalli K.C. El-Rahyel A.E. et al.Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >10 mm.Gastrointest Endosc. 2021; 93: 654-659Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar “Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >10 mm.” It is reassuring that data continue to accumulate that cold snare polypectomy of medium to large sessile lesions is safe and effective. What is not addressed is the amount of solid waste that the technique described may unnecessarily generate. The technique used by McWhinney et al1McWhinney C.D. Vemulapalli K.C. El-Rahyel A.E. et al.Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions >10 mm.Gastrointest Endosc. 2021; 93: 654-659Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar involved injecting either hydroxyethyl starch mixed with a contrast agent or Eleview (Aries Pharmaceutical). Piecemeal resection was then used for “nearly all” lesions. As the authors are surely aware, for most serrated lesions of almost any size, submucosal lifting is not necessary to remove them in a piecemeal manner. As noted in the article, these lesions “separate easily from the submucosal tissue.” If the endoscopist pays close attention to the lesion’s borders, and starts the resection from the dependent portion so that any bleeding does not obscure the remainder of the lesion, most serrated lesions can be completely resected in a piecemeal fashion without submucosal lifting. It has been estimated that 1 endoscopic procedure generates 1.5 kg of plastic waste, of which only 0.3 kg is recyclable; the rest goes to landfill sites. Adding submucosal injections to a polypectomy uses a contrast agent and its packaging, an injection needle and its packaging, and syringes to draw up the solution, among other items. Although the use of these devices is necessary at times, it should be avoided whenever possible. We all have to do our part to decrease our carbon footprint.2Gayam S. Environmental impact of endoscopy: "scope" of the problem.Am J Gastroenterol. 2020; 115: 1931-1932Crossref PubMed Scopus (10) Google Scholar The author disclosed no financial relationships. Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions ≥10 mmGastrointestinal EndoscopyVol. 93Issue 3PreviewCold EMR is being increasingly used for large serrated lesions. We sought to measure residual lesion rates and adverse events after cold EMR of large serrated lesions. Full-Text PDF ResponseGastrointestinal EndoscopyVol. 94Issue 3PreviewI appreciate Dr Skole’s1 point regarding plastic waste. Certainly, endoscopists could and should pay more attention to this issue. Full-Text PDF