Cold Snare Endoscopic Mucosal Resection Research Articles

Addition of dilute epinephrine to commercially available submucosal lifting agents for cold snare endoscopic mucosal resection

Addition of dilute epinephrine to commercially available submucosal lifting agents for cold snare endoscopic mucosal resection

Methodological issues in the evaluation of cold snare endoscopic mucosal resection for colon polyps.

Methodological issues in the evaluation of cold snare endoscopic mucosal resection for colon polyps.

Cold snare endoscopic mucosal resection for colonic polyps: addressing methodological critiques and enhancing future discussions.

Cold snare endoscopic mucosal resection for colonic polyps: addressing methodological critiques and enhancing future discussions.

Outcomes of cold snare EMR of nonampullary duodenal adenomas ≥1 cm: a multicenter study

Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas≥1 cm. This was a multicenter retrospective study of patients with nonampullary duodenal adenomas≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence. A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n= 28). Adverse events occurred in 3.9% (n= 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P= .036). This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.

Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis.

Cold snare endoscopic mucosal resection (CS-EMR) can reduce the risks associated with electrocautery during colon polyp resection. Data on efficacy are variable. This systematic review and meta-analysis aimed to estimate the pooled efficacy and safety rates of CS-EMR. We conducted a comprehensive literature search of multiple databases, from inception to March 2023, for studies addressing outcomes of CS-EMR for colon polyps. The weighted pooled estimates with 95 %CIs were calculated using the random effects model. I2 statistics were used to evaluate heterogeneity. 4137 articles were reviewed, and 16 studies, including 2592 polyps in 1922 patients (51.4 % female), were included. Overall, 54.4 % of polyps were adenomas, 45 % were sessile serrated lesions (SSLs), and 0.6 % were invasive carcinomas. Polyp recurrence after CS-EMR was 6.7 % (95 %CI 2.4 %-17.4 %, I2 = 94 %). The recurrence rate was 12.3 % (95 %CI 3.4 %-35.7 %, I2 = 94 %) for polyps ≥ 20 mm, 17.1 % (95 %CI 4.6 %-46.7 %, I2 = 93 %) for adenomas, and 5.7 % (95 %CI 3.2 %-9.9 %, I2 = 50 %) for SSLs. The pooled intraprocedural bleeding rate was 2.6 % (95 %CI 1.5 %-4.5 %, I2 = 51 %), the delayed bleeding rate was 1.5 % (95 %CI 0.8 %-2.7 %, I2 = 18 %), and no perforations or post-polypectomy syndromes were reported, with estimated rates of 0.6 % (95 %CI 0.3 %-1.3 %, I2 = 0 %) and 0.6 % (95 %CI 0.3 %-1.4 %, I2 = 0 %), respectively. CS-EMR demonstrated an excellent safety profile for colon polyps, with variable recurrence rates based on polyp size and histology. Large prospective studies are needed to validate these findings.

The efficacy and safety of cold snare polypectomy with submucosal injection for the removal of polyps less than 20mm in size: a systematic review and meta-analysis.

Neoplastic polyp removal is important for colorectal cancer prevention. Endoscopists have proposed cold snare endoscopic mucosal resection (CS-EMR) as a solution to solve positive cutting edges and postoperative bleeding. However, many controversies regarding its specific performance in practice have been reported. The aim of this pooled analysis was to report the efficacy and safety of CS-EMR. PubMed/Medline, Embase, Google Scholar, and the Cochrane Library searched up to January 2022 to identify studies in which CS-EMR was performed for the removal of colorectal polyps measuring less than 20mm. The primary outcome was the complete resection rate (CRR), and the secondary outcome was the rate of adverse events. Eleven studies were included in the final analysis, which included 861 colorectal polyps. The overall CRR with CS-EMR was 96.3% (95% CI, 93.9-98.2%). The early and delayed bleeding rates of CS-EMR were 3.1% (95% CI, 1.2-5.5%) and 1.4% (95% CI, 0.6-2.4%), respectively. There were no statistical significances between CS-EMR and cold snare polypectomy (CSP) in terms of the CRR and adverse events, as well as CS-EMR and hot snare endoscopic mucosal resection (HS-EMR). For resecting colorectal polyps measuring ≤20mm, CS-EMR is an effective attempt. However, compared with CSP and HS-EMR, CS-EMR did not improve the efficiency and safety of polypectomy as expected. Multicenter randomized controlled trials are needed to compare CSP with CS-EMR in the resection of <10mm polyps and HSP with CS-EMR in the resection of ≥10mm polyps.

Efficacy and Safety of Cold Snare Endoscopic Mucosal Resection (CS-EMR) for Nonampullary Duodenal Polyps: Systematic Review and Meta-Analysis.

There is an increasing interest in cold snare endoscopic mucosal resection (CS-EMR), and studies have shown its safety and efficacy for colonic polyps. This meta-analysis aims to assess the safety and efficacy of CS-EMR for the removal of duodenal adenomas. We conducted a comprehensive literature search of several databases, from inception through February 2023, for studies that addressed outcomes of CS-EMR for nonampullary duodenal adenomas. We used the random-effects model for the statistical analysis. The weighted pooled rates were used to summarize the technical success, polyp recurrence, bleeding, and perforation events. Cochran Q test and I2 statistics adjudicated heterogeneity. Six studies were included in the analysis. In all, 178 duodenal polyps were resected using CS-EMR. The pooled rates were 95.8% (95% CI 89.1-98.5%, I2=21.5%) for technical success and 21.2% (95% CI 8.5-43.6%, I2=78%) for polyp recurrence. With regards to CS-EMR safety, the pooled rates were 4.2% (95% CI 1.6-10.5%, I2=12%) for immediate bleeding, 3.4% (95% CI 1.5-7.6%, I2=0%) for delayed bleeding, 2.8% (95% CI 1.1-6.7%, I2=0%) for perforation, and 2% (95% CL 0.5-7.5%, I2=0%) for post-polypectomy syndrome. Rates were not significantly different for large adenomas. Three studies reported data on CS-EMR and conventional EMR. Compared with conventional EMR, CS-EMR had lower odds of delayed bleeding, OR 0.11 (CI 0.02-0.62, P value 0.012, I2=0%). Our findings suggest that CS-EMR is a safe and effective strategy for the resection of nonampullary duodenal adenomas, with an acceptable recurrence rate. Data from larger randomized controlled studies are needed to validate our findings.

Endoscopic Management of Large Non-Pedunculated Colorectal Polyps.

Large non-pedunculated colorectal polyps ≥20 mm (LNPCPs) comprise approximately 1% of all colorectal polyps. LNPCPs more commonly contain high-grade dysplasia, covert and overt cancer. These lesions can be resected using several means, including conventional endoscopic mucosal resection (EMR), cold-snare EMR (C-EMR) and endoscopic submucosal dissection (ESD). This review aimed to provide a comprehensive, critical and objective analysis of ER techniques. Evidence-based, selective resection algorithms should be used when choosing the most appropriate technique to ensure the safe and effective removal of LNPCPs. Due to its enhanced safety and comparable efficacy, there has been a paradigm shift towards cold-snare polypectomy (CSP) for the removal of small polyps (<10 mm). This technique is now being applied to the management of LNPCPs; however, further research is required to define the optimal LNPCP subtypes to target and the viable upper size limit. Adjuvant techniques, such as thermal ablation of the resection margin, significantly reduce recurrence risk. Bleeding risk can be mitigated using through-the-scope clips to close defects in the right colon. Endoscopic surveillance is important to detect recurrence and synchronous lesions. Recurrence can be readily managed using an endoscopic approach.

Comparative efficacy and safety of resection techniques for treating 6 to 20mm, nonpedunculated colorectal polyps: A systematic review and network meta-analysis.

Various endoscopic resection techniques have been proposed for the treatment of nonpedunculated colorectal polyps sized 6-20mm, however the optimal technique still remains unclear. A comprehensive literature review was conducted for randomized controlled trials (RCTs), investigating the efficacy of endoscopic treatments for the management of 6-20mm nonpedunculated colorectal polyps. Primary outcomes were complete and en bloc resection rates and adverse event rate was the secondary. Effect size on outcomes is presented as risk ratio (RR; 95% confidence interval [CI]). Fourteen RCTs (5219 polypectomies) were included. Endoscopic mucosal resection(EMR) significantly outperformed cold snare polypectomy(CSP) in terms of complete [(RR 95%CI): 1.04(1.00-1.07)] and en bloc resection rate [RR:1.12(1.04-1.21)]. EMR was superior to hot snare polypectomy (HSP) [RR:1.04(1.00-1.08)] regarding complete resection, while underwater EMR (U-EMR) achieved significantly higher rate of en bloc resection compared to CSP [RR:1.15(1.01-1.30)]. EMR yielded the highest ranking for complete resection(SUCRA-score 0.81), followed by cold-snare EMR(CS-EMR,SUCRA-score 0.76). None of the modalities was different regarding adverse event rate compared to CSP, however EMR and CS-EMR resulted in fewer adverse events compared to HSP [RR:0.44(0.26-0.77) and 0.43(0.21-0.87),respectively]. EMR achieved the highest performance in resecting 6-20mm nonpedunculated colorectal polyps, with this effect being consistent for polyps 6-9 and ≥10mm; findings supported by very low quality of evidence.

Endoscopic mucosal resection using cold snare versus hot snare in treatment for 10–19 mm non-pedunculated colorectal polyps: protocol of a non-inferiority randomised controlled study

IntroductionCold polypectomy has the advantages of simple operation, less time-consuming and fewer complications. Guidelines have recommended cold snare polypectomy (CSP) to resect small polyps sized ≤5 mm and sessile polyps...

WEO Newsletter.

WEO Newsletter.

S161 Cold Snare Endoscopic Mucosal Resection for Colon Polyps: A Systematic Review and Meta-Analysis

Introduction: Cold snare endoscopic mucosal resection (CS-EMR) has become increasingly popular for the removal of colon polyps > 10 mm. CS-EMR can potentially avert some of the risks associated with the use of electrocautery during polyp resection without compromising clinical efficacy. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of CS-EMR in removing colon polyps. Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language addressing outcomes of CS-EMR for colon polyps from database inceptions through April 2022. The weighted pooled estimates with the 95% confidence interval (CI) were calculated. Cochran Q test and I2 statistics were used to evaluate heterogeneity. Results: We identified 3599 articles on the initial search, and 32 full-text studies were assessed for eligibility. Fifteen studies met inclusion criteria. There were three randomized controlled trials, six prospective, and six retrospective studies. Six studies were from the United States, two each from Australia, China, and Japan, one from the United Kingdom, and one from Greece. A total of 2382 polyps were removed from 1756 patients. 45% were females. Polyps ranged from 6-80 mm in size, and 72.4% were proximal to the splenic flexure. In addition, 50.4% of the polyps were NICE I or serrated lesions and 48.5% were NICE II, and 0.1% were NICE III. Polyp recurrence rate after CS-EMR was 9.4 % (95% CI: 3.3-15.6%, I2= 95.8%), piecemeal resection rate 59.4% (95% CI: 46.3-72.4%, I2= 99.9%), and complete histological resection rate (defined by post polypectomy biopsies) was 93.1% (95% CI: 88.7-97.6%, I2=90.8%). For adverse events, delayed post-polypectomy bleeding rate was 0.8% (95% CI: 0.3-1.3%, I2= 21.4%), perforation and the post-polypectomy syndrome rate was 0.3% (95% CI: 0-0.5%, I2= 0%) (Figure). Given significant heterogeneity in recurrence rate, subgroup analyses were performed. Recurrence rate in serrated lesions (n=484) was 3.8% (95% CI: 0.2-7.4%, I2= 76.7%), in polyps < 20 mm (n= 137) 0.8% (95% CI: -0.7-2.3%, I2= 0%), and in polyps ≥ 20 mm (n=617) 15.7% (95% CI: 2.6-28.7%, I2= 95.2%). Conclusion: CS-EMR has an excellent safety profile and acceptable recurrence rate for resection of colon polyps, especially for polyps < 20 mm and serrated lesions. However, large prospective studies to validate safety and efficacy are needed.Figure 1.: Forest plots of A) recurrence rate, B) complete histological resection, C) delayed post polypectomy bleeding, and D) perforation of cold snare endoscopic mucosal resection in colon polyps

A122 OUTCOMES OF COLD SNARE POLYPECTOMY FOR POLYPS GREATER THAN 20 MM: DATA FROM AN ACADEMIC CENTER

BackgroundCold snare polypectomy (CSP) is widely utilized for resection of small polyps (less than 10mm), due to the technique’s favourable safety profile. However, Hot Snare Endoscopic Mucosal Resection (HSEMR) remains the standard of care for large polyps greater than or equal to 20mm. HSEMR carries an increased risk of complications. These include delayed bleeding, perforation, and post-polypectomy syndrome, along with residual or recurrent adenomatous (RRA).More recently, Cold Snare Endoscopic Mucosal Resection (CSEMR) technique has been used selectively for polyps greater than 20mm. Published studies have demonstrated a significantly lower adverse event rate of complications as compared with HSEMR. RRA utilizing CSP remains a concern, with a recent publication reporting a recurrence of 34.8% on follow-up endoscopy. We present the experience at a single Canadian academic centre with patients undergoing CSEMR for polyps greater than 20mm.AimsTo demonstrate the efficacy and safety of cold snare endoscopic mucosal resection CSEMR of large (greater than or equal to 20mm) polyps at a single Canadian academic centre.MethodsWe retrospectively reviewed colonoscopies performed by endoscopists employing this technique at our centre from January 2020 to August 2021. 15 total cases were identified for patients with polyps greater than or equal to 20 mm, removed by CSEMR technique.ResultsPatient age ranged from 41 to 76, with a median patient age was 66. There were 10 males and 5 females. There were no adverse events intraoperatively. 15/15 (100%) polyps were successfully resected using CSEMR technique. Polyp size ranged from 2 cm to 7 cm, and there was a median polyp size of 3 cm. 14/15 (93%) polyps were proximal to the splenic flexure, with 1/15 (7%) polyp in the rectum. 6/15 (40%) patients received snare tip soft coagulation to the edges of the polypectomy site. Polyp histology included 7 tubular adenomas, 3 tubulovillous adenomas, 4 sessile serrated polyps, and one hyperplastic polyp. Two patients were on aspirin 81 mg daily, and there were zero patients on any other antiplatelets or anticoagulation. 1/15 patient presented with late bleeding requiring emergent colonoscopy. There were no immediate or delayed perforations or other serious adverse events recorded.Approximately 50% of patients have had follow-up colonoscopy within 3–6 months of their initial procedure. Follow-up ranged from 12 to 252 days, with a median time to follow up of 171 days. 3/7 (43%) patients had histologic evidence of recurrence at follow-up colonoscopy, all of which were successfully treated endoscopically.ConclusionsSelective CSEMR is a safe and effective technique, with a low risk of complications. There may be a higher rate of residual polyp at follow-up colonoscopy compared to HSEMR. This data will need further validation with a larger sample size. Funding AgenciesNone

A30 RECURRENCE RATES AFTER ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BackgroundComplete polyp resection is the main goal of endoscopic removal of large colonic polyps. Resection techniques used for their removal have evolved in recent years and endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) with margin ablation, cold snare polypectomy (CSP), cold snare EMR and underwater EMR have been introduced. Yet, efficacy of these techniques with regard to local recurrence rates (LRR) compared to traditional hot snare polypectomy (HSP) and standard EMR remains unclear.AimsWe aimed to analyze LRR of large colonic polyps in a systematic review and meta-analysis.MethodsMEDLINE, EMBASE, EBM Reviews, and CINAHL databases were searched to identify prospective studies reporting LRR or incomplete resection rate (IRR) after colonic polypectomy of polyps >10 mm, published between January 2011 and July 2021. Primary outcome was LRR for polyps >10 mm.Results6928 publications were identified, of which 34 prospective studies were included into the analysis. LRR for polyps >10 mm at follow-up (FU) up to 12 months was 11.0% (95% CI 7.1–14.8; 15 studies; 6259 polyps). ESD (1.7%; 95% CI 0–3.4; 3 studies, 221 polyps) and EMR with margin ablation (3.3%; 95% CI 2.2–4.5; 2 studies, 947 polyps) significantly reduced LRR compared to standard EMR without (15.2%; 95% CI 12.5–18.0%; 4 studies, 650 polyps) or with unsystematic margin ablation (16.5%; 95% CI 15.2–17.8; 6 studies, 3183 polyps).ConclusionsLocal polyp recurrence after standard EMR of large colonic polyps is high. LRR is significantly lower after ESD or EMR with routine margin ablation, so that these techniques should be considered standard for endoscopic removal of large colorectal polyps. CSP, cold snare EMR and underwater EMR should only be used within clinical trials until more high-quality data regarding LRR becomes available. Funding AgenciesNone

Postpolypectomy syndrome after cold snare endoscopic mucosal resection

A 51-year-old woman underwent colonoscopy as part of the living kidney donor selection process. Consequently, a 7-mm suspected sessile serrated lesion was detected at the ascending colon (A). Cold snare EMR was performed after submucosal injection with 1:100,000 epinephrine solution (B, C). On the night of the procedure, right lower quadrant abdominal pain and a fever of 38.1°C occurred. On the next day, the pain persisted, with localized tenderness, and the patient’s temperature reached 38.5°C.

Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20 mm: a retrospective chart review.

Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥ 20 mm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥ 20 mm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥ 20 mm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8 %) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older ( P = 0.008), had endoscopic clips placed at index procedure ( P = 0.017), and were more likely to be Asian and African American ( P = 0.02). ARR was higher in larger polyps ( P < 0.001), tubulovillous adenomas ( P < 0.001), and polyps with high-grade dysplasia ( P = 0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥ 20 mm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.

Cold or Hot Snare with Endoscopic Mucosal Resection for 6-9 mm Colorectal Polyps: A Propensity Score Matching Analysis.

Objective: To investigate the efficacy and safety of cold snare endoscopic mucosal resection (CS-EMR) and hot snare endoscopic mucosal resection (HS-EMR) for colorectal polyps with diameters of 6-9 mm. Methods: Retrospective analysis was performed on the clinical data of 485 patients with colorectal polyps (6-9 mm in size) who were treated with CS-EMR or HS-EMR in the endoscopy center of Hangzhou Third People's Hospital from January 2017 to December 2019. Colorectal polyps were lifted by submucosal injection of normal saline. The CS-EMR group used a cold snare to remove the lifting polyps, while the HS-EMR group used a hot snare. Propensity score matching analysis with 1:1 matching and the nearest neighbor matching method were performed to ensure well-balanced characteristics of the CS-EMR and HS-EMR groups. Matching factors included age, gender, body mass index, blood routine, coagulation indicators, polyp site, size, number, and morphology. This resulted in a balanced cohort of 128 patients per group. Polyp recovery, complications, clipping for disclosure, and length of hospital stay were compared after matching. t-Tests, χ2 tests, McNemar's tests, and Fisher's exact test were used for comparison between the two groups before and after matching. Results: There were no differences between the two groups of intraoperative and postoperative bleeding (P > .05), but the CS-EMR clipping rate was lower than the HS-EMR group (P < .01). There was a higher incidence of post-polypectomy syndrome (PPS) (P = .03) and longer hospital stays (P < .01) in the HS-EMR group than the CS-EMR group. Conclusions: Compared with HS-EMR, CS-EMR is more convenient to operate, with a low incidence of PPS, clipping rates, and short hospital stays. It is a safe and effective removal method for 6-9 mm colorectal polyps.

Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?

Background/AimsCold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps. MethodsBetween 2018 and 2019, 100 consecutive small colorectal polyps (5–10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected. ResultsNo difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006–1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, 3.853–322.397) showed a significantly increased risk of bleeding. ConclusionsThe effect of submucosal injection in CSP was not significant for small colorectal polyps.

Cold snare endoscopic mucosal resection for the removal of large nonpedunculated colon polyps.

Cold snare endoscopic mucosal resection for the removal of large nonpedunculated colon polyps.

Mo1716 SAFETY AND EFFICACY OF COLD SNARE VERSUS HOT SNARE ENDOSCOPIC MUCOSAL RESECTION (EMR) FOR NON-PEDUNCULATED POLYPS ≥ 20MM

Traditional endoscopic mucosal resection (EMR) using hot snare (HS-EMR) is associated with increased risks of bleeding and perforation for large polyps. Cold snare EMR (CS-EMR), which entails submucosal injection followed by cold snare polypectomy, is a newer technique that may be safer due to lack of electrocautery use and may be preferable in high-risk patients (i.e. elderly, patients on anticoagulants/antiplatelets). While data shows CS-EMR may be effective for polyps 10-20mm, there is little data on the use of CS-EMR for large polyps ≥ 20mm. This study aims to assess the safety and efficacy of CS-EMR versus HS-EMR for non-pedunculated polyps ≥ 20mm. We performed a retrospective study at a tertiary care referral center including patients undergoing piecemeal or en bloc CS-EMR or HS-EMR of non-pedunculated polyps ≥ 20mm from January 2015 to March 2019. Adverse events (AEs) were defined by presence of post-polypectomy syndrome, perforation, or delayed bleeding requiring hospitalization, blood transfusions or repeat colonoscopy, within 30 days of index colonoscopy. Efficacy was assessed by the absence of residual adenomatous tissue at follow-up colonoscopy completed from January 2015 to November 2019. Statistical comparison was performed using Fisher’s exact test. 209 patients (97 CS-EMR; 112 HS-EMR) with 220 colonic polyps ≥ 20mm (103 CS-EMR; 117 HS-EMR) were included. In the CS-EMR group, mean patient age was 66.7 years ± 11.3, 57.7% were male, and 36.1% were on anticoagulants/antiplatelets. In the HS-EMR group, mean patient age was 65.9 years ± 11.0, 56.3% were male, and 49.2% were on anticoagulants/antiplatelets. Mean polyp size was 29.3mm ± 10.2 in the CS-EMR group and 25.6mm ± 7.8 in the HS-EMR group. 140 (63.6%) colonic polyps had follow-up surveillance colonoscopies with a median of 271 (56 – 1316) days from index colonoscopy. Residual adenomas during follow-up (determined via biopsy at prior EMR site) were found in 14 (21.8%) CS-EMR cases and 23 (30.2%) HS-EMR cases, which were not significantly different (p=0.337). Post-polypectomy bleeding (9.4% vs. 0%, p < 0.001) and composite adverse events of bleeding, perforation and post-polypectomy syndrome (12.0 % vs. 0%, p < 0.001) were higher in the HS-EMR group compared to the CS-EMR group. CS-EMR appears to be safe for resection of polyps ≥ 20mm with low rates of AEs and similar rates of adenoma clearance compared to HS-EMR. CS-EMR may be especially beneficial in high-risk patients. Significant rates of residual adenoma were present in both groups, which may be due to a tertiary referral center population with polyps previously manipulated, difficult locations including appendiceal orifice, and larger size of polyps. Additional randomized comparative studies are needed to demonstrate the safety and efficacy of CS-EMR compared to HS-EMR polypectomy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)