S2133 Suck and Snare: A Technique for Rapid, Complete, and Safe Cold Snare Polypectomy of Sessile Polyps Greater Than One Centimeter

Abstract

Introduction: Snare polypectomy of flat colon polyps may be challenging when boarders are indistinct or if the snare wire slides over the flat mucosal surface as the snare closes. Current guidelines suggest cold or hot snare polypectomy with or without submucosal injection for the removal of polyps between 1 and 1.9 centimeters (cm). Injection lift polypectomy and hot snare endoscopic mucosal resection of flat lesions can be time intensive and carries risks of perforation, post polypectomy syndrome, and bleeding. Cold snare technique has become increasingly utilized for Paris class 1s and 1sp polyps of any size. We propose an adaptation of the “suction polypectomy technique,” previously described for the removal of less than 1 cm sessile polyps, for use in cold snare polypectomy of sessile polyps greater than 1 cm. Case Description/Methods: Technique: Olympus high definition colonoscopes (CF-HQ190L/I) were used to identify sessile polyps between 10-15 mm (Table). The snare was passed though the instrument and pulled back slightly into the channel. Polyps were then suctioned using the tip of endoscope for 1-2 seconds. This technique was repeated over the surface of the entire lesion until the polyps puckered up, developing a more polypoid shape. The polyps were then immediately resected via cold snare polypectomy (Figure). All polyps were completely resected and there were no procedural complications. Discussion: This series shows that the “suction polypectomy” technique using a cold snare for polyps 1 cm or greater is feasible and safe with the benefits of not requiring the use of lifting agents, injection needles, or significant technical expertise. Future studies are required to determine the feasibility of suction polypectomy in lesions greater than 1.5 cm and the safety and efficacy of the technique in larger prospective cohorts.Figure 1.: Endoscopic images of the technique. Images labeled “A” show the polyp before suction. Images labeled “B” show the polyp after suction. Images labeled “C” show post-polypectomy. Table 1. - Characteristics of Polyps Removed Patient # Polyp Size Location Pathology Diagnosis En Bloc versus Piecemeal Complications (Immediate/Delayed Bleeding or Perforation) 1 10 mm Descending Colon Tubular Adenoma in Fragments En Bloc None 2 10 mm Ascending Colon Sessile Serrated Adenoma En Bloc None 3 12 mm Ascending Colon Sessile Serrated Adenoma En Bloc None 4 12 mm Ascending Colon Tubular Adenoma in Fragments En Bloc None 5 11 mm Transverse Colon Tubular Adenoma En Bloc None