Cold Snare Technique Research Articles

Novel cold snare technique with clipping for duodenal angioectasia.

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Cold-snare endoscopic resection of non-ampullary duodenal adenomas: Systematic review and pooled-analysis

BackgroundMirroring the experience with colonic resections, cold snare-based techniques have been recently proposed for non-ampullary duodenal lesions to reduce the risk of adverse events (AEs). As the duodenal wall is thinner and more vascularized than in the colon, electrocautery-related AEs are relevant issues in this setting. AimsWe performed a systematic review with pooled-analysis to evaluate the efficacy and safety of this technique. MethodsElectronic databases (Medline, Scopus, EMBASE) were searched up to January 2023. Full articles including patients with duodenal lesions resected by cold-snare technique were eligible. The adverse events (i.e., bleeding, perforation, stricture), complete resection, and recurrence rates were pooled using a random model. ResultsEleven studies were eligible, providing data on 3137 lesions removed from 233 patients. The overall AE rate for cold snaring was 0.25% (95% CI, 0.19%-0.69%). Among the three studies comparing cold- and hot-snare approaches, procedure-related bleeding rate was significantly lower with cold approach (OR 1.21, 0.51–2.85; p = 0.66). The complete resection rate was 99.40% (95% CI, 98.60%-100%), with a residual/recurrence rate of 12.95% (95% CI, 4.75%-21.16%). On univariate meta-regression, lesion size significantly affected both the adverse events and recurrence risk. ConclusionCold-snare resection appears effective and extremely safe for resecting non-ampullary duodenal lesions.

Safety and efficacy of a new cold snare technique with clipping for colorectal angioectasia.

Colorectal angioectasia is a major cause of lower gastrointestinal bleeding. Use of antithrombotic agents is expected to increase with aging of the population, and bleeding from angioectasia is an important issue. Although the effectiveness of endoscopic mucosal resection for colorectal angioectasia has been reported, there are no reports of cold snare technique for angioectasia (CSA). From February 2018 to February 2022, the safety of CSA was evaluated at Omori Red Cross Hospital. We investigated the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding) after CSA and the incidence of rebleeding requiring repeated endoscopic treatment. During the study period, 106 angioectasias were identified during colonoscopy. We only targeted patients with bloody stools and/or anemia requiring treatment for bleeding from angioectasia. Finally, we included 11 angioectasias in this study. Rates of DPPB and rebleeding after CSA were 0 %. The rate of immediate bleeding during CSA was 27.3 % (3/11). Dilated capillaries could be observed pathologically in nine of 11 lesions (81.8 %). CSA was safe and can be a new treatment option in the future. To confirm our results and verify the long-term safety and efficacy of CSA, further studies are desirable.

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

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

S2014 Disseminated Histoplasmosis Presenting as Right Colon Lesions in HIV-Negative Patients: Report of Two Cases

Introduction: Histoplasma capsulatum is the most common endemic mycosis in the gastrointestinal tract of immunocompromised hosts. However, it can also present in immunocompetent patients. Terminal ileum and cecum are most commonly affected, recognized on endoscopic examination as inflammation, ulcerated lesions, or polypoid masses. In most patients, gastrointestinal manifestation takes a subclinical disease course. We present 2 cases of immunocompetent patients with colon lesions attributed to disseminated histoplasmosis. Case Description/Methods: First case is a 62-year-old African American woman admitted to the hospital due to abdominal pain, weight loss and poor oral intake. She was found to be anemic. CT revealed a large retroperitoneal mass with central necrosis suspicious for malignancy. Colonoscopy revealed a cecal ulcer (Figure A) with pathology reporting mucosal ulceration associated with granulomatous inflammation. GMS and PAS fungal stain showed small ovoid yeast forms, morphologically compatible with histoplasmosis (Figure B).Biopsy of the retroperitoneal mass was also positive for histoplasma. Second case is a 54-year-old Hispanic man admitted to the hospital with fluid overload secondary to acute renal failure attributed to post-infectious glomerulonephritis. He was also found to have anemia. Colonoscopy showed a 6 mm polyp in the ascending colon removed by cold snare technique (Figure C). Pathology reported polyp fragment with macrophages and numerous 2-4 micron non-budding yeast forms best seen on GMS stain, most consistent with histoplasmosis. CT scan showed prominent retroperitoneal lymphadenopathy. Both our patients were started in itraconazole and are being closely followed by the ID service. Discussion: Disseminated histoplasmosis is usually seen in immunocompromised patients such as those with HIV and medication-induced immunosuppression. GI involvement and symptoms can be diverse. Our first patient presented with a large retroperitoneal mass and cecal ulcer causing her abdominal discomfort. Second patient was much more subtle as histoplasmosis presented as a polypoid lesion. Both patients presented with significant anemia, which prompted endoscopic evaluation. Although the diagnosis of histoplasmosis in immunocompetent patients usually requires a high index of suspicion, gastroenterologists should be familiar with its variable presentations in the GI tract.Figure 1.: a) Histoplasma presenting as cecal ulcer. b) GMS stain showing Histoplasma. c) Polypoid lesion positive for Histoplasma.

ID: 3525121 EFFICACY OF COLD SNARE ENDOSCOPIC MUCOSAL RESECTION FOR SESSILE SERRATED LESIONS COMPARED TO ADENOMATOUS LESIONS

Background and Aim: Endoscopic mucosal resection (EMR) with a cold snare is gaining increasing acceptance as an effective therapy for large laterally spreading lesions in the colon. The cold snare technique offers a favorable risk profile, with low rates of bleeding, perforation, and post-procedure pain compared to the more widely used hot snare EMR technique. While there is increasing acceptance of cold snare EMR for the removal of medium (10-19mm) and large (≥20mm) sessile serrated lesions (SSLs), concerns remain about its suitability for the removal of similar sized adenomas. We aimed to study the differences in safety and efficacy of cold snare EMR for SSLs as compared to adenomas at our institution.

Mucosal defect size predicts the adequacy of resection of ≤10 mm nonpedunculated colorectal polyps using a new cold snare polypectomy technique.

There is still room for improvement in the methods used to achieve complete polyp resection. The aim of this study was to develop a cold snare polypectomy technique that will reliably result in resections containing the muscularis mucosae and the lateral polyp margins. Nonpedunculated polyps ≤10 mm were resected using a dedicated cold snare with the goal of creating a mucosal defect approximately 1 cm in dia. The completeness of resection of the lateral and vertical polyp margins was examined histologically. The cases of 201 patients (mean age 67 ± 13 years; 115 men) with 500 eligible polyps were enrolled. The mean polyp size was 6.1 ± 1.8 mm (range 1-10 mm). The mean mucosal defect size immediately after resection was 7.7 ± 2.5 mm (range 3-15 mm). Overall, the complete resection rate in which the lateral and vertical margins were free from the neoplasia tissue was 92% (417/454, 95% CI, 89-94); in the remaining 8% of cases, the vertical margins showed complete resection but the lateral margins could not be evaluated due to the fragmentation of resected polyps. A mucosal defect ≥7 mm predicted complete resection of the mucosal layer containing the muscularis mucosae. Complete mucosal layer resection of nonpedunculated colorectal polyps ≤10 mm was reliably achieved using a cold snare technique that produced a mucosal defect ≥7 mm in dia.

S1763 Asymptomatic Systemic Sarcoidosis Diagnosed From Diminutive Polyp During Screening Colonoscopy

INTRODUCTION: Sarcoidosis is a multisystem non-necrotizing granulomatous disease which primarily involves the lungs in African Americans. Extraintestinal involvement, though rare, may involve both liver and luminal organs with a variety of presentations and severity. We present an asymptomatic case of systemic sarcoidosis diagnosed during a screening colonoscopy. Luminal disease is rare and is a diagnosis of exclusion, necessitating a thorough differential and evaluation. CASE DESCRIPTION/METHODS: A 37-year-old asymptomatic African-American female presented for high risk screening for colon cancer, with a strong family history of colon cancer. Colonoscopy revealed a single 3 mm Paris-1s polyp removed completely via cold snare technique, and was otherwise unremarkable including the terminal ileum. Pathology revealed an inflammatory polyp with prominent submucosal non-necrotizing granulomatous inflammation. At follow-up, she revealed very mild decrease in exercise capacity but denied any other pulmonary symptoms. An EGD was performed for completion and was unremarkable including biopsies of stomach and small bowel. A CT chest found extensive mediastinal and hilar lymphadenopathy without lung nodule or parenchymal disease, as well as porta hepatis lymphadenopathy. An endobronchial ultrasound again revealed bilateral hilar lymphadenopathy, and mediastinal lymphadenopathy with transbronchial needle aspiration confirming hyalinized granulomas consistent with sarcoidosis. DISCUSSION: Sarcoidosis is a global multi-organ systemic disease characterized by non-necrotizing granulomas. It primarily involves the pulmonary system and extrapulmonary disease is less than 10% cases, including skin, eyes, liver, and luminal disease. This can become an infiltrative, possibly fatal, disease of the liver and heart. Gastric sarcoidosis may result in isolated ulcers, gastritis, and friable mucosa with granulomas, or a more diffuse infiltration pattern which may result in fibrosis and stenosis. Due to the rarity of colonic sarcoid, other diseases need to be ruled out including tuberculosis, syphilis, inflammatory bowel disease, Whipple’s disease, diffuse Histoplasma, and H. Pylori infection from the stomach. ACE levels are not recommended to diagnose sarcoid, however may help differentiate with IBD if there is isolated colonic or small bowel disease. Our patient was treated with a slow taper of prednisone 20 mg and 200 mcg fluticasone furoate inhalation powder with respiratory symptom resolution.Figure 1.: Paris-1s colon polyp histologic analysis diagnosing asymptomatic systemic sarcoidisos. This is an inflammatory polyp with prominent submucosal non-necrotizing granulomas (A) with moderate granulomatous inflammation (B).Figure 2.: Chest Computed Tomography transverse (C) and coronal (D) images revealing bilateral hilar lymphadenopathy (arrows) in an asymptomatic case of systemic sarcoidosis.

Mo1652 SMALL POLYP (6-9 MM) RESECTION: ADOPTION OF OPTIMAL TECHNIQUE OVER TIME

Cold snare technique has emerged as the optimal technique for removal of small (6-9 mm) polyps to avoid incomplete resection (associated with cold biopsy resection) and bleeding/perforation complications (associated with hot snare technique). Describe small polyp (6-9 mm) resection technique from 2012 to 2019. We conducted a single center retrospective study at an academic Veterans Affairs Medical Center including colonoscopies performed between 2012-2019 where a polyp 6-9 mm was removed. Procedures were performed by board certified gastroenterologists and surgeons. Chart review was performed to collect patient characteristics, procedure findings, polypectomy technique and pathology results. Resection techniques over time are displayed overall as well as stratified by different specialties and level of experience. Monotonic trends over time were examined using the Mann-Kendall test and the resulting p-values and tau test statistics are provided. Seventeen gastroenterologists and four surgeons performed 773 procedures where a 6-9 mm polyp was removed. There was a significant increase in cold snare use from 2012-2019 overall (tau 0.86, p=0.004) and individually for both specialties (GI: tau 0.64, p=0.035; surgery: tau 0.90, p=0.007) (table). There was a sharp increase in cold snare use among gastroenterologists from 2015 (72.0%) to 2016 (97.1%) and remained over 95% thereafter. For surgeons, there was a sharp increase in cold snare use from 2016 (75.9%) to 2017 (90.9%) and remained over 90% thereafter. From 2017 and onward, zero 6-9 mm polyps were removed with a cold forceps by gastroenterologists. Trainee involvement in procedures followed similar trends of improved practice over time (figure). Over time, there was significant improvement in adoption of cold snare resection for 6-9 mm polyps by both gastroenterologists and surgeons. Gastroenterologists appeared to adopt optimal practice earlier than surgeons and have had a longer standing zero-tolerance use of cold biopsy forceps for these polyps compared to surgeons. Although encouraging that all endoscopists are adopting optimal technique, delayed uptake based on specialty emphasizes the importance of standardizing continuing education and quality assurance across specialties.Trend in polyps removed using the different resection techniques overtime. For each year the proportion of polyps removed using a given resection technique are displayed as % (N). These results are displayed overall as well as stratified by different specialties and level of experience. Monotonic trends overtime were evaluated using the Mann-Kendall test and specialty groups with significant trends are displayed with corresponding asterisks.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Safety and Efficacy of Dedicated Cold versus Standard Snares

Introduction: Cold snare is a polyp removal technique using a metal snare to catch and remove a polyp without electrocautery, which is used in heat snare. Recently, it has become common practice to use dedicated cold snares instead of standard snares for cold polypectomy. Dedicated cold snare technique may have fewer complications such as delayed bleeding. Our study was designed to examine outcomes of safety based on bleeding and efficacy defined as en bloc resection for dedicated cold snare versus standard snares. Another aim was to identify predictors of bleeding including type of snare. Methods: All patients who had an outpatient colonoscopy at an academic VA medical center from 1/2017 to 5/2018 were eligible to participate in our observational study. Several different dedicated cold snare and standard snare types were rotated each month across all endoscopists. The 2 outcomes examined in this analysis were en bloc resection (versus piecemeal) and bleeding (none, mild, and requiring treatment). The exposure variable was the use of standard vs dedicated cold snare. Data collected included polyp size, location, shape, whether resection was en bloc or piecemeal, and post-polypectomy bleeding, in addition to patient characteristics and type/training level of specialists doing the exam. Data were analyzed using Pearson Chi-Square and generalized linear models. Outcome for bleeding was dichotomized (none versus mild/requiring treatment). All analyses were at the polyp level. Results: A total of 2,450 polyps from 899 patients were removed. 82% of polyps were < 5mm; 15% were 6-9 mm, and less than 3% were > 10 mm. 75 % were flat, and 25% were protruding (sessile or pedunculated). 61% of polyps were located in the right colon, 31% in the left colon, and 7.5% in the rectum (See Table 1). While there was more mild bleeding with the dedicated cold snare as compared to the standard snare, there was no difference in bleeding requiring intervention (1.3% vs 1.2%) (Table 2). There was also no difference in en bloc vs piecemeal resection between snare types (Table 3). Conclusion: Our study adds to the growing data showing that the removal of polyps with dedicated cold snares is as safe and effective as polypectomy with standard snares. Not surprisingly, size is the biggest predictor of bleeding, regardless of snare type.488_A Figure 1. Outcomes of bleeding for dedicated cold versus standard snare as stratified by polyp size488_B Figure 2. Outcomes of en bloc vs piecemeal resection for dedicated cold versus standard snare as stratified by polyp size488_C Figure 3. Factors associated with bleeding (none versus mild or requiring treatment) with dedicated cold snare technique

A comparative study of cold snare and hot snare resection of small colorectal polyps

Objective: To compare the effect of cold snare and hot snare on the resection of small colorectal polyps, and to explore the clinical value of cold snare technique in removing colorectal polyps. Methods: From September 1, 2017 to January 31, 2018, 206 cases of patients with colorectal polyp resection in the Department of Gastroenterology of Peking University International Hospital were studied. During this period, according to the standard, 103 cases of patients (158 polyps) were in the cold snare group, and 103 patients (180 polyps) were randomly selected as control group from patients of the hot snare group. The related clinical data were analyzed retrospectively. The location, shape, size, polypectomy time, pathological type, complete resection rate, specimen recovery rate, complications and related costs of the two groups of polyps were compared. Results: The polypectomy time of the cold snare group was shorter than that of the hot snare group.The difference was statistically significant (Z=-11.727, P<0.001). The related cost of the perioperative period of the cold snare group was lower than that of the hot snare group.The difference was statistically significant (Z=-12.680, P<0.001). There were no statistically significant differences in the number of polyps/case, size, shape, pathological classification, complete resection rate, specimen recovery rate, and perioperative complications of the patients in the two groups(P>0.05). Conclusions: The operation time of cold snare technique in colorectal polyps (6-9 mm in diameter) is shorter and the cost is lower, which is worthy of clinical promotion.

Cold snare resection for the treatment of benign airway lesions.

The objective was to assess the safety and outcome of cold snare technique used by flexible bronchoscopy in the treatment of airway benign neoplasms. The clinical data of 21 patients, who had airway benign neoplasm and were treated through the cold snare method in Sir Run Run Shaw Hospital, affiliated with the Zhejiang University, were retrospectively analyzed. The relief of the symptoms and occurrence of complications were observed and evaluated. All the tumors were benign and removed by cold snare. Postoperatively, we found that the treatment was completely effective in 12 patients, and there was a significant improvement in 7 patients and a moderate improvement in 2 patients, and no recurrence in follow-up visit. In conclusion, the cold snare technique is an economically feasible, safe, and effective method in the treatment of airway neoplasms.

What is the best therapeutic strategy for colonoscopy of colorectal neoplasia? Future perspectives from the East.

Development and improvement of endoscopic techniques and devices have changed the treatment of colorectal tumors over the last decade. For the treatment of diminutive polyps, the cold snare technique of the West is becoming a promising treatment in the East because of its short procedure time and low rate of delayed bleeding by eliminating the delayed effect of electrocautery. Rather than using piecemeal endoscopic mucosal resection or surgical resection for the treatment of large superficial tumors, the technique of the East of endoscopic submucosal dissection (ESD) achieves a high success rate of en bloc R0 resection, enabling detailed pathological evaluation with less invasive treatment. This procedure should also be useful in the West where large colorectal tumors are more frequent than in the East. Regarding outcomes, however, in the literature, the definition of 'curative resection' remains somewhat inconsistent and long-term outcomes of patients with deep submucosal and/or lymphovascular invasion in the en bloc specimen have not yet been determined. Large prospective, as well as retrospective, studies of these patients are warranted. When colorectal ESD is difficult because of size or location, the pocket-creation method and/or double-balloon-assisted technique may be useful. In the East, high-quality magnified chromoendoscopy is widely available, and endoscopists try to identify focal submucosal invasion. In the West, a systematic evaluation of surveillance for the prevention of colorectal cancer has been done and is highly refined. The East and West have much to learn from each other.

Expanding the field of cold snare polypectomy.

Expanding the field of cold snare polypectomy.

Cold snare piecemeal resection of colonic and duodenal polyps ≥1 cm.

Background: Endoscopic removal of duodenal and colorectal adenomas is currently considered to be the standard of care for prevention of adenocarcinoma. The use of cautery carries a risk of delayed bleeding, post-polypectomy syndrome, and perforation. We examined the safety and feasibility of removing colonic and duodenal polyps ≥ 1 cm using a piecemeal cold snare polypectomy technique. Patients: The study included 15 patients with duodenal polyps ≥ 1 cm and 15 patients with colonic polyps ≥ 1 cm. Main outcome measurements: Bleeding, perforation, abdominal pain, or hospitalization occurring within 2 weeks of polypectomy. Results: Between 24 August 2011 and 29 April 2013, 15 patients had removal of duodenal polyps ≥ 1 cm. Mean patient age was 64 years and 9/15 patients were male. The mean polyp size was 24 mm (10 – 60 mm). All polyps were removed with a cold snare and some required cold biopsy forceps. One patient required hospitalization for gastrointestinal blood loss 7 days post-polypectomy; this patient was using Coumadin. Between 27 February 2012 and 30 May 2013, 15 patients underwent resection of a ≥ 1 cm colonic polyp. Mean patient age was 68 years and 9/15 were male. The mean polyp size was 20 mm (10 – 45 mm). All polyps were primarily removed with a cold snare. None of the patients required hemostatic clips for control of immediate bleeding. One patient presented to the emergency department with abdominal pain 1 day after initial endoscopy. CT scan showed no abnormalities and the patient was discharged. Conclusions: Cold snare polypectomy for large duodenal and colonic polyps is technically feasible and may have a favorable safety profile compared to standard electrocautery-based endoscopic resection. Comparative trials are required to determine the relative safety and efficacy of cold snare techniques for complete and durable resection of large polyps compared to standard hot snare methods.

Cold snare polypectomy: does snare type influence outcomes?

Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown. Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation. One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare. Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique.

Tu1451 Cold SNARE Polypectomy (CSP) for Large Sessile Colonic Polyps: a Single-Center Experience

Snare resection with cautery has conventionally been used for polypectomy of large colonic polyps, while cold snare technique has been reserved for smaller polyps, typically less than 5 mm in size. The primary aim of this case series is to determine outcomes of using CSP for large/advanced sessile polyps.

The current practice standard for colonoscopy in Australia

Despite having one of the highest rates per capita for colonoscopy worldwide, colorectal cancer remains the second most commonly diagnosed malignancy in Australia. Our aim was to document colonoscopy/polypectomy practice nationwide and assess whether significant differences exist. Observational study. Online survey conducted nationally in2012. Medical practitioners registered with the Gastroenterological Society of Australia practicing colonoscopy. Rates of polypectomy techniques for varying polyp sizes, postpolypectomy bleeding prophylaxis techniques, and adenoma detection practices. To assess whether variations exist according to practice location, specialty, and experience and comparison of practice with a previous American cohort. Of the 846 members contacted, 244 (28.8%) responded. The cohort consisted primarily of consultant gastroenterologists (182/244, 74.6%). The cold-snare technique was preferred (165/244, 67.6%) for polyps 3mm in size; however, this decreased rapidly with increasing polyp size (5mm [120/244, 49.2%] and 7-9mm [18/244, 7.4%]). EMR was the preferred method of resection for polyps 7 to 9mm in size (148/244, 60.7%). The withdrawal technique predominantly consisted of double-passing high-risk areas and rectal retroflexion (134/244, 54.9%). Significant differences across specialty, location, and experience included polypectomy method for diminutive polyps, the use of EMR, and retroflexion. Survey-based study and response rate. Although variations in colonoscopy and polypectomy practice exist, the majority of our cohort performs cold-snare polypectomy for diminutive polyps and pass high-risk, poorly visualized areas twice on withdrawal. This is a significant shift in practice from that of the U.S. cohort studied 10 years earlier.

Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy

The bleeding risk after cold snare polypectomy in anticoagulated patients is not known. To compare the bleeding risk after cold snare polypectomy or conventional polypectomy for small colorectal polyps in anticoagulated patients. Prospective randomized controlled study. Municipal hospital in Japan. Anticoagulated patients with colorectal polyps up to 10mm in diameter were enrolled. Patients were randomized to polypectomy with either cold snare technique (Cold group) or conventional polypectomy (Conventional group) without discontinuation of warfarin. The primary outcome measure was delayed bleeding (ie, requiring endoscopic intervention within 2 weeks after polypectomy). Secondary outcome measures were immediate bleeding and retrieval rate of colorectal polyps. Seventy patients were randomized (159 polyps): Cold group (n= 35, 78 polyps) and Conventional group (n= 35; 81 polyps). The patients' demographic characteristics including international normalized ratio and the number, size, and shape of polyps removed were similar between the 2 techniques. Immediate bleeding during the procedure was more common with conventional polypectomy (23% [8/35]) compared with cold polypectomy (5.7% [2/35]) (P= .042). No delayed bleeding occurred in the Cold group, whereas 5 patients (14%) required endoscopic hemostasis in the Conventional group (P= .027). Complete polyp retrieval rates were identical (94% [73/78] vs 93% [75/81]). The presence of histologically demonstrated injured arteries in the submucosal layer with cold snare was significantly less than with conventional snare (22% vs 39%, P= .023). Small sample size, single-center study. Delayed bleeding requiring hemostasis occurred significantly less commonly after cold snare polypectomy than conventional polypectomy despite continuation of anticoagulants. Cold snare polypectomy ispreferred for removal of small colorectal polyps in anticoagulated patients. ( NCT 01553565.).

PWE-201 Techniques for removal of polyps from the right colon: how are we doing them?

IntroductionPolypectomy is a commonly performed therapeutic intervention and all colonoscopists should be able to perform the procedure safely and effectively. Complications can include perforation and bleeding. Practice has evolved considerably...