Safer removal of large polyps with cold snare technique

Traditionally, the removal of smaller colorectal polyps, i.e. less than 10 mm in size, has been performed using cold snare endoscopic mucosal resection (CS-EMR), while larger polyps, i.e. 20 mm and above, have typically been removed using hot snare endoscopic mucosal resection (HS-EMR). This new study aimed to compare the efficacy and safety of CS-EMR in removing large colorectal polyps.

The prospective, randomised, controlled trial, presented by Dr Ingo Steinbrück (Evangelisches Diakoniekrankenhaus Freiburg, Germany), enrolled 394 participants with non-pedunculated colorectal polyps measuring 20 mm or more [1]. This study primarily focused on major complications such as perforation or clinically significant post-endoscopic bleeding.

The results of this intention-to-treat analysis showed that the CS-EMR group had a significantly lower rate of major complications at 1% compared with the 8% observed in the HS-EMR group (P=0.001). These included a lower incidence of perforation (0% vs 4%; P=0.007) and post-endoscopic bleeding in the CS-EMR group (1% vs 4.5%; P=0.038).

In addition to these primary findings, the study also shed light on various secondary outcomes. For instance, the CS-EMR group exhibited a lower intraprocedural bleeding rate than the HS-EMR group (14% vs 22.9%; P=0.023). Still, the technical success rate was slightly lower in the CS-EMR group than in the HS-EMR group (92.2% vs 97.5%; P=0.017).

Dr Steinbrück concluded: "CS-EMR is superior in safety to HS-EMR, almost eliminating major adverse events. However, it presents a higher rate of residual neoplasia, necessitating careful lesion selection to mitigate recurrence risks.” Further analysis is required to identify the most suitable lesions for CS-EMR and to explore technical and procedural enhancements that could bolster its effectiveness.

1. 
   
   1. Steinbrück I, et al. Cold vs. hot snare resection of non-pedunculated polyps ≥2cm in the colorectum – first results from the prospective, randomized, controlled, multicentric CHRONICLE trial. LB06, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

Copyright ©2023 Medicom Medical Publishers



Posted on 7 December 20237 December 2023