Cold snare polypectomy safe, effective

WASHINGTON — Cold snare polypectomy safely removed small colonic polyps with minimal immediate complications and no known late complications, according to data presented at Digestive Disease Week.

“The technique of cold snare polypectomy is used to remove [small colonic polyps] without diathermy, which implies that a polyp is transected by a snare along with a rim of surrounding normal mucosa” Jonathan (Yong) C. Tan, MBBS, from The Alfred Hospital in Melbourne, Australia, said in his presentation. “Hence, cold snare polypectomy theoretically allows complete polyp removal without the potential complications of electrocautery, in particular the complications of delayed bleeding and perforation.”

Aiming to assess the efficacy and safety of cold snare polypectomy in a real world setting, Tan and colleagues performed a nonrandomized prospective study of 88 patients (median age, 65 years; 54 males) who underwent colonoscopy where at least one sessile polyp was removed using cold snare. Afterward, two to four cold biopsies taken at polyp margins were sent for histologic assessment of residual polyp, and patients were contacted 2 weeks after the procedure to assess complications. The researchers also performed univariate analysis to determine predictors of post-polypectomy residual polyp tissue.

“The primary outcome was completeness of polyp resection, the secondary outcome was looking at complications, in particular … bleeding and perforation,” Tan said. “The initial data was presented at DDW 2011; the study was reopened in 2014 with additional data supplemented.”

In total, 153 polyps (median 5 mm; range, 2-12 mm) were removed (9.8% cecum, 21.6% ascending colon, 5.2% hepatic flexure, 20.2% transverse colon, 9.8% descending colon, 23.5% sigmoid colon, 1.3% rectosigmoid and 8.5% rectum). All were removed en-bloc except for 8.5% which were removed piecemeal (up to two pieces); 76.4% were low grade dysplastic adenomas, 14.4% were hyperplastic and 9.2% were sessile serrated adenomas. Residual polyp tissue was observed in 4.6% of all polyps, and the only complication was immediate post-polypectomy oozing in one patient on warfarin who had five polyps removed and clips were applied.

“In summary 4.6% of polyps in our study had residual polyp tissue at the post-polypectomy margin histologically,” Tan said. “There was no identifiable factor seen in this study to be found predictive of residual polyp tissue post-polypectomy. Cold snare polypectomy is safe with minimal immediate complications and no known late complications.” – by Adam Leitenberger

For more information:

Tan J, et al. Abstract 714. Presented at: Digestive Disease Week, May 16-19, 2015; Washington, D.C.

Disclosure: Tan reports no relevant financial disclosures. Please see the DDW faculty disclosure index for all other researchers’ relevant financial disclosures.