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. 2015 Nov 25;7(17):1250-6.
doi: 10.4253/wjge.v7.i17.1250.

Feasibility of cold snare polypectomy in Japan: A pilot study

Yoji Takeuchi  1 , Takeshi Yamashina  1 , Noriko Matsuura  1 , Takashi Ito  1 , Mototsugu Fujii  1 , Kengo Nagai  1 , Fumi Matsui  1 , Tomofumi Akasaka  1 , Noboru Hanaoka  1 , Koji Higashino  1 , Hiroyasu Iishi  1 , Ryu Ishihara  1 , Henrik Thorlacius  1 , Noriya Uedo  1
Affiliations

Feasibility of cold snare polypectomy in Japan: A pilot study

Yoji Takeuchi et al. World J Gastrointest Endosc. .

Abstract

Aim: To investigate the feasibility of cold snare polypectomy (CSP) in Japan.

Methods: The outcomes of 234 non-pedunculated polyps smaller than 10 mm in 61 patients who underwent CSP in a Japanese referral center were retrospectively analyzed. The cold snare polypectomies were performed by nine endoscopists with no prior experience in CSP using an electrosurgical snare without electrocautery.

Results: CSPs were completed for 232 of the 234 polyps. Two (0.9%) polyps could not be removed without electrocautery. Immediate postpolypectomy bleeding requiring endoscopic hemostasis occurred in eight lesions (3.4%; 95%CI: 1.1%-5.8%), but all were easily managed. The incidence of immediate bleeding after CSP for small polyps (6-9 mm) was significantly higher than that of diminutive polyps (≤ 5 mm; 15% vs 1%, respectively). Three (5%) patients complained of minor bleeding after the procedure but required no intervention. The incidence of delayed bleeding requiring endoscopic intervention was 0.0% (95%CI: 0.0%-1.7%). In total, 12% of the resected lesions could not be retrieved for pathological examination. Tumor involvement in the lateral margin could not be histologically assessed in 70 (40%) lesions.

Conclusion: CSP is feasible in Japan. However, immediate bleeding, retrieval failure and uncertain assessment of the lateral tumor margin should not be underestimated. Careful endoscopic diagnosis before and evaluation of the tumor residue after CSP are recommended when implementing CSP in Japan.

Keywords: Cold snare polypectomy; Colonoscopy; Colorectal neoplasm; Endoscopic gastrointestinal surgery; Polypectomy.

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Figures

Figure 1
Figure 1
Actual cold snare polypectomy procedure. A: A 5-mm flat adenoma located in the sigmoid colon; B: The electrosurgical snare is opened and pressed against the colonic wall; C: The lesion and surrounding normal non-neoplastic mucosa are grasped and cut without electrocautery; D: Mucosal defect after cold snare polypectomy. Oozing immediately occurred after the procedure but stopped within a few minutes.
See this image and copyright information in PMC

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