Non-pedunculated Polyps Research Articles

S1051 Similar Rates of Histologic-Confirmed Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Among General Gastroenterologists and Advance Endoscopists

Introduction: Endoscopic mucosal resection (EMR) technique is the most common approach for non-pedunculated colonic polyps ≥20 mm. EMR is usually performed by both general gastroenterologists and advance endoscopists. EMR performed by advanced endoscopists have been associated with decreased risk of incomplete polyp resection, but little is known about the recurrence rate of large non-pedunculated polyps performed by general gastroenterologists. Thus, we aim to investigate recurrence rate and EMR characteristics for non-pedunculated polyps ≥20 mm performed by general gastroenterologists. Methods: Retrospective study of patients who undergone EMR of non-pedunculated polyps ≥20 mm at Ben Taub and Veteran’s Affairs (VA) hospital in Houston, Texas from 2012 to 2019. Patients who had two stage procedures, non-neoplastic histology or evidence of invasive cancer were excluded. Patients were divided by type of endoscopist who performed index colonoscopy. Demographic data, polyp and resection characteristics were analyzed. Univariate and multivariate analyzed were performed. Results: A total of 522 non-pedunculated polyps were included from 470 unique patients. 271 polyps had EMR performed by general gastroenterologists and 199 polyps by advance endoscopists. 177 lesions in the general gastroenterologist group completed at least 1 surveillance colonoscopy, 49 (27.7%) had histologic recurrence. 150 lesions in the advance endoscopists group completed at least 1 surveillance colonoscopy, 46 (30.7%) had histologic recurrence. The average polyp size of the cohort was 28.6 mm. Polyps from male patients (85.6% vs 74.4%, P = 0.002) at the VA hospital (82.7% vs 55.3%, P ≤ 0.001) were more likely to be resected by general gastroenterologists. Other demographic characteristics were comparable among groups. There were no significant differences between groups in polyp size, histological recurrence, delayed post-polypectomy bleeding and/or post procedural pain prompting abdominal imaging. Advance endoscopists were more likely to use clips for prophylactic defect closure and less likely to have intraprocedural bleeding (Table 1). Conclusion: General gastroenterologists had a similar recurrence rate after EMR of non-pedunculated polyps ≥20 mm compared with advanced endoscopists. Advance endoscopists had less intraprocedural bleeding but delayed post-polypectomy bleeding rate was comparable.Table 1.: Univariable and multivariable logistic regression analysis of polyp resection characteristics

S281 Predictors of Histologic-Confirmed Endoscopic Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Larger Than 20 mm

S281 Predictors of Histologic-Confirmed Endoscopic Recurrence After Endoscopic Mucosal Resection (EMR) of Non-Pedunculated Polyps Larger Than 20 mm

Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?

Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?

Covering the Cover

Covering the Cover

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.

ID: 3524319 USE OF ADJUNCTIVE REMOVAL TECHNIQUES FOR ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLONIC POLYPS IS PREDICTIVE OF POLYP RECURRENCE

Endoscopic mucosal resection (EMR) allows for safe and effective removal of large non-pedunculated colon polyps. However, prior studies have shown significant recurrence rates between 10-30% after EMR, which have led to recommendations for close endoscopic follow-up and the use of techniques such as snare tip soft coagulation (STSC) to EMR margins to prevent recurrence. Models such as the Size/Morphology/Site/Access score (SMSA) have been developed to aid in identifying polyp complexity and patients at high risk of recurrence. Numerous individual risk factors for recurrence have previously been reported, however the significance of these factors have varied between studies, with limited data from Canadian centres.

Impact of technical innovations in EMR in the treatment of large nonpedunculated polyps involving the ileocecal valve (with video)

The endoscopic management of large nonpedunculated colorectal polyps involving the ileocecal valve (ICV-LNPCPs) remains challenging because of its unique anatomic features, with long-term outcomes inferior to LNPCPs not involving the ICV. We sought to evaluate the impact of technical innovations and advances in the EMR of ICV-LNPCPs. The performance of EMR for ICV-LNPCPs was retrospectively evaluated in a prospective observational cohort of LNPCPs≥20mm. Efficacy was measured by clinical success (removal of all polypoid tissue during index EMR and avoidance of surgery) and recurrence at first surveillance colonoscopy. Accounting for the adoption of technical innovations, comparisons were made between an historical cohort (September 2008 to April 2016) and contemporary cohort (May 2016 to October 2020). Safety was evaluated by documenting the frequencies of intraprocedural bleeding, delayed bleeding, deep mural injury, and delayed perforation. Between September 2008 to October 2020, 142 ICV-LNPCPs were referred for EMR. Median ICV-LNPCP size was 35mm (interquartile range, 25-50mm). When comparing the contemporary (n= 66) and historical cohorts (n= 76) of ICV-LNPCPs, there were significant differences in clinical success (93.9% vs 77.6%, P=.006) and recurrence (4.6% vs 21.0%, P= .019). With technical advances, ICV-LNPCPs can be effectively and safely managed by EMR, independent of lesion complexity. Most patients experience excellent outcomes and avoid surgery.

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis.

Background/AimsRecent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm. MethodsWe performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR. ResultsA total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%. ConclusionsOur systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps.

BACKGROUND AND STUDY AIM : Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of nonpedunculated polyps larger than 20 mm reduces the incidence of severe delayed bleeding, especially in proximal polyps. This study aimed to evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. METHODS : This is a post hoc analysis of the CLIP study (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when no remaining mucosal defect was visible and clips were less than 1 cm apart. Factors associated with complete closure were evaluated in multivariable analysis. RESULTS : In total, 458 patients (age 65, 58 % men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4 %); closure was not complete for 156 (31.6 %). Factors associated with complete closure in adjusted analysis were smaller polyp size (odds ratio 1.06 for every millimeter decrease [95 % confidence interval 1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). CONCLUSIONS : Complete clip closure was not achieved for almost one in three resected large nonpedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable. This highlights the need for alternative closure options and measures to prevent bleeding.

Snare rotation technique: a simple tip for successful polypectomy for non-pedunculated gastrointestinal polyps.

Snare rotation technique: a simple tip for successful polypectomy for non-pedunculated gastrointestinal polyps.

A61 USE OF ADJUNCTIVE REMOVAL TECHNIQUES FOR ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLONIC POLYPS IS PREDICTIVE OF POLYP RECURRENCE

Abstract Background Endoscopic mucosal resection (EMR) allows for safe and effective removal of large non-pedunculated colon polyps. However, prior studies have shown significant recurrence rates between 10–30% after EMR, which have led to recommendations for close endoscopic follow-up and the use of techniques such as snare tip soft coagulation (STSC) to EMR margins to prevent recurrence. Models such as the Size/Morphology/Site/Access score (SMSA) have been developed to aid in identifying polyp complexity and patients at high risk of recurrence. Numerous individual risk factors for recurrence have previously been reported, however the significance of these factors have varied between studies, with limited data from Canadian centres. Aims To evaluate predictors of recurrence for large non-pedunculated polyps following EMR. Methods Consecutive patients between April 1, 2017 to March 1, 2019 who underwent EMR were retrospectively identified from endoscopy unit administrative records. Patients with non-pedunculated colorectal polyps ≥ 2 cm that were removed by EMR were included if follow-up endoscopy data were available. Polyps found to contain invasive adenocarcinoma on histology and/or were referred for surgical resection were excluded. Patient demographic, pre-procedural, intra-procedural, and post-procedural data to time of first follow-up colonoscopy were extracted. Recurrence was defined as a positive pathology specimen from the EMR scar at follow-up. Adjunctive techniques were defined as the use of any non-snare resection or ablation technique for removal of visible adenoma at the time of the EMR. Chi-square and multivariate regression analyses were conducted for variables of interest. Results 517 patients underwent large polyp EMR during the study time period with 265 patients satisfying inclusion criteria. Median age of patients was 67 years (IQR 14); 48% were female. STSC was performed to EMR margins in 94% of cases. 30.9% and 69.1% of polyps were SMSA grade 3 and grade 4 respectively. Adjunctive removal techniques were utilized in 31% of patients, 95% of which was hot avulsion. 15% of patients had recurrence on follow-up endoscopy. Higher SMSA grade was associated with the use of adjunctive techniques (20% vs. 37%, p=0.006). The use of adjunctive removal techniques (OR 2.92, p=0.007) and male gender (OR 3.45, p=0.002) were the only factors found to be significantly predictive of recurrence on multivariate analysis. Conclusions Male gender and the use of adjunctive removal techniques, particularly hot avulsion, are independently predictive of recurrence after EMR of large complex colorectal polyps. Male patients and those who require hot avulsion may be considered high risk for recurrence and warrant closer follow-up. Funding Agencies None

Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

BackgroundEndoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk.MethodsThe CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding.DiscussionThe CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice.Trial registrationClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

The Cost of Clipping-How Much Does Price Matter?

Clip closure is effective for large (≥ 20 mm) nonpedunculated polyps in the proximal colon. The cost-effectiveness analysis by Albeniz et al. found that selective clipping of polyps at a minimum risk (>13% in the United States, >10% in Spain) is worthwhile clipping. Although such model is theoretically sound, clinical practice should be primarily guided by efficacy data. Moreover, the analysis is very sensitive to the high price of clips, which is likely to reduce in the foreseeable future.

Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis.

Background and study aims Underwater endoscopic mucosal resection (UEMR) for colorectal polyps has been reported to have good outcomes in recent studies. We conducted a systematic review and meta-analysis comparing the effectiveness and safety of UEMR to conventional EMR (CEMR). Methods A comprehensive search of multiple databases (through May 2020) was performed to identify studies that reported outcome of UEMR and CEMR for colorectal lesions. Outcomes assessed included incomplete resection, rate of recurrence, en bloc resection, adverse events (AEs) for UEMR and CEMR. Results A total of 1,651 patients with 1,704 polyps were included from nine studies. There was a significantly lower rate of incomplete resection (odds ratio [OR]: 0.19 (95 % confidence interval (CI), 0.05–0.78, P = 0.02) and polyp recurrence (OR: 0.41, 95 % CI, 0.24–0.72, P = 0.002) after UEMR. Compared to CEMR, rates overall complications (relative risk [RR]: 0.66 (95 % CI, 0.48–0.90) ( P = 0.008), and intra-procedural bleeding (RR: 0.59, 95 % CI, 0.41–0.84, P = 0.004) were significantly lower with UEMR. The recurrence rate was also lower for large non-pedunculated polyps ≥ 10 mm (OR 0.24, 95 % CI, 0.10–0.57, P = 0.001) and ≥ 20 mm (OR 0.14, 95 % CI, 0.02–0.72, P = 0.01). The rates of en bloc resection, delayed bleeding, perforation and post-polypectomy syndrome were similar in both groups ( P > 0.05). Conclusions In this systematic review and meta-analysis, we found that UEMR is more effective and safer than CEMR with lower rates of recurrence and AEs. UEMR use should be encouraged over CEMR.

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.

Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer.

Endoscopic Recognition and Management Strategies for Malignant Colorectal Polyps: Recommendations of the US Multi-Society Task Force on Colorectal Cancer.

Colorectal EMR outcomes in octogenarians versus younger patients referred for removal of large (≥20 mm) nonpedunculated polyps

Data are limited on safety and outcomes of colorectal EMR in octogenarians (≥80 years old). We sought to review outcome data for patients aged≥80 in a prospectively collected database of patients referred for large polyp removal. We retrospectively evaluated a database of patients referred for large (≥20mm) nonpedunculated polyp removal. From 2000 to 2019, we compared the rates of follow-up, recurrence, adverse events, and synchronous neoplasia detection between younger patients and patients aged≥80. There were 167 patients aged≥80 years and 1686<80 years. Patients in the elderly group returned for surveillance less often (67.1% vs 75.1%, P= .024), had greater first follow-up recurrence rates (27.5% vs 13.8%, P< .001), but had similar adverse event rates (1.8% vs 2.8%, P= .619) compared with younger patients. Rates of synchronous neoplasia were similar and high in both groups. EMR is safe and well tolerated for large polyp removal in patients over 80 years old. Patients aged≥80 years are less likely to present for follow-up after EMR. They had a higher recurrence rate and a similarly high prevalence of synchronous precancerous lesions. Follow-up after EMR should be encouraged in the elderly, and an attempt to clear the colon of synchronous disease at the time of the initial EMR may be warranted.

S0139 Underwater vs Conventional Endoscopic Mucosal Resection for Colorectal Lesions: A Systematic Review and Meta-Analysis

INTRODUCTION: Underwater endoscopic mucosal resection (UEMR) for colorectal polyps has been reported to have good outcomes in recent studies. We conducted a systematic review and meta-analysis studying efficacy and safety of UEMR as compared to conventional EMR (CEMR). METHODS: A comprehensive search of multiple databases (through May 2020) was performed to identify studies that reported outcome of UEMR and CEMR for colorectal lesions. Odds ratio was calculated for outcomes comparing CEMR and UEMR. Outcomes assessed included adverse events, intra-procedural bleeding, delayed bleeding, perforation, post-polypectomy syndrome, incomplete resection, en bloc resection, R0 resection and rate of recurrence amongst UEMR and CEMR. Subgroup analysis was performed for non-pedunculated polyps ≥10 mm and ≥20 mm. All analysis was performed using RevMan 5.0 (Cochrane Collaboration). RESULTS: A total of 1,651 patients with 1,704 polyps were included from 9 studies. The mean age and polyp size ranged from 62.3 to 70 years and 9.9 mm to 30.2 mm, respectively. 66.4% of patients were males. Adverse events were 91 (10.2%) in CEMR group and 59 (7.2%) in UEMR group. Compared to CEMR, overall complications (odds ratio [OR]: 0.61 (95% CI, 0.42–0.88) (P = 0.009), and intra-procedural bleeding (OR: 0.54, 95% CI, 0.36–0.81, P = 0.003) was significantly lower with UEMR (Figure 1a and 1b). There was also a significantly lower rate of incomplete resection (OR: 0.19 (95% CI, 0.05–0.78, P = 0.02) and polyp recurrence (OR: 0.41, 95% CI, 0.24–0.72, P = 0.002) after UEMR (Figure 2a and 2b). Odds of R0 resection were significantly higher in UEMR as compared to CEMR with OR of 2.20 (95% CI, 1.26–3.83, I2 = 0, P = 0.0005) (Figure 2c). There were 1,204 polyps ≥10 mm (612 CEMR and 592 UEMR), and 294 polyps (166 CEMR and 128 UEMR) were ≥ 20 mm. The recurrence rate was lower for non-pedunculated polyps ≥10 mm (OR 0.24, 95% CI, 0.10–0.57, P = 0.001) and ≥20 mm (OR 0.14, 95% CI, 0.02–0.72, P = 0.01). The rate of en bloc resection, delayed bleeding, perforation and post-polypectomy syndrome were similar in both groups (P > 0.05). All results along with subgroup analysis are summarized in Table 1. CONCLUSION: In this systematic review and meta-analysis, we found that UEMR is safer and more effective than CEMR with lower rates of adverse events and recurrence. UEMR use should be encouraged over CEMR.Figure 1.: Forest plot showing odds ration of any complication (A) and intra-procedural bleeding (B) comparing conventional endoscopic mucosal resection and underwater endoscopic mucosal resection.Figure 2.: Forest plot showing odds ratio of incomplete resection (A), R0 resection (B) and recurrence (C) comparing conventional endoscopic mucosal resection and underwater endoscopic mucosal resection.Table 1.: All Results along with subgroup analysis of non-pedunculated polyps ≥ 10 mm and ≥20 mm comparing underwater and conventional endoscopic mucosal resection

Incomplete endoscopic resection of colorectal polyps: a prospective quality assurance study.

Endoscopic screening with polypectomy has been shown to reduce colorectal cancer incidence in randomized trials. Incomplete polyp removal and subsequent development of post-colonoscopy cancers may attenuate the effect of screening. This study aimed to quantify the extent of incomplete polyp removal. We included patients aged 50-75 years with nonpedunculated polyps ≥ 5 mm removed during colonoscopy at four hospitals in Norway. To evaluate completeness of polyp removal, biopsies from the resection margins were obtained after polypectomy. Logistic regression models were fitted to identify factors explaining incomplete resection. 246 patients with 339 polyps underwent polypectomy between January 2015 and June 2017. A total of 12 polyps were excluded due to biopsy electrocautery damage, and 327 polyps in 246 patients (mean age 67 years [range 42-83]; 52 % male) were included in the analysis. Overall, 54 polyps (15.9 %) in 54 patients were incompletely resected. Histological diagnosis of the polyp (sessile serrated lesions vs. adenoma, odds ratio [OR] 10.9, 95 % confidence interval [CI] 3.9-30.1) and polyp location (proximal vs. distal colon, OR 2.8, 95 %CI 1.0-7.7) were independent risk factors for incomplete removal of polyps 5-19 mm. Board-certified endoscopists were not associated with lower rates of incomplete resection compared with trainees (14.0 % vs. 14.2 %), OR 1.0 (95 %CI 0.5-2.1). Incomplete polyp resection was frequent after polypectomy in routine clinical practice. Serrated histology and proximal location were independent risk factors for incomplete resection. The performance of board-certified gastroenterologists was not superior to that of trainees.

Colonoscopic Polypectomy Preferences of Asian Endoscopists: Results of a Survey-Based Study.

Background/AimsThe clinical practice pattern of polypectomy is not well-investigated in Asian countries. We aimed to survey Asian endoscopists about their preferred polypectomy techniques for given conditions and images of polyps.MethodsA survey was performed using questionnaires composed of two parts a scenario-based questionnaire using scenarios of polyps, which were adopted from the European Society of Gastrointestinal Endoscopy guidelines, and an image-based questionnaire using provided endoscopic images of polyps.ResultsA total of 154 endoscopists participated in this survey. The most preferred resection techniques for diminutive (≤5 mm), small (6–9 mm), and benign-looking intermediate (10–19 mm) nonpedunculated polyps were cold forceps polypectomy, hot snare polypectomy, and endoscopic mucosal resection (EMR), respectively, in both the scenario- and image-based questionnaires. For benign-looking large (≥20 mm) nonpedunculated polyps, EMR and endoscopic submucosal dissection (ESD) were preferred in the scenario- and image-based surveys, respectively. In case of malignant nonpedunculated polyps, EMR and ESD were preferred for intermediate-sized and large lesions, respectively, according to the scenario-based survey. However, ESD was preferred in both intermediate-sized and large malignant nonpedunculated polyps according to the image-based survey. Trainee endoscopists, endoscopists working in referral centers, and endoscopists in the colorectal cancer–prevalent countries were independently associated with preference of cold snare polypectomy for removing small polyps.ConclusionsThe polypectomy practice patterns of Asian endoscopists vary, and cold snare polypectomy was not the most preferred resection method for polyps <10 mm in size, in contrast to recent guidelines. (Gut Liver 2021;15-400)