Polypectomy Techniques

Polyps in the upper and lower gastrointestinal tract can be premalignant or malignant lesions that can be treated endoscopically in early stages to prevent morbidity and more invasive procedures. This article critically reviews the techniques available and provides recommendations for endoscopic polypectomy.

[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.

Standardisation of polypectomy technique

There are several approaches to polypectomy for sessile polyps <20 mm and for pedunculated polyps. Recent evidence is leading towards standardisation of polypectomy technique. Key recent polypectomy developments include: 1. Use of cold snare polypectomy (CSP) for sessile polyps <10 mm; 2. Use of hot snare polypectomy (HSP) following submucosal injection for sessile polyps sized 10-19 mm; 3. Piecemeal cold snare polypectomy (PCSP), with or without prior submucosal injection, for select sessile polyps sized 10-19 mm, where the potential risk for an adverse event is increased (e.g. polyps in the caecum or ascending colon, or patients with increased risk of post-polypectomy bleeding), and where the risk of submucosal invasion is low; 4. Avoidance of hot biopsy forceps (HBF); 5. Limiting the use of cold biopsy forceps (CBF) to the smallest of diminutive polyps, where CSP is not feasible; 6. Mechanical haemostasis prior to polypectomy for large pedunculated polyps with head ≥20 mm or stalk ≥10 mm.