Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10-14 mm in diameter

Abstract

Background and aim: Cold snare polypectomy (CSP) is commonly used for treating colorectal polyps <10 mm in diameter. We evaluated the analysis and safety of CSP for larger polyps.

Methods: We retrospectively analyzed 1006 colorectal polyps resected with CSP. Indication for CSP was polyps 2-14 mm that were diagnosed as benign neoplastic polyp by magnifying endoscopy. Various clinicopathological characteristics were analyzed. Multivariate analyses were used to determine the independent risk factors for failure of complete CSP resection. With respect to polyp size, we compared the therapeutic outcomes between polyps <10 mm and ≥10 mm. Additionally, the presence of muscularis mucosa in resected specimens was analyzed.

Results: Rates of en bloc resection and postoperative hemorrhage were 98.8% and 0.1%, respectively. Seven hundred and ninety-one neoplastic lesions were analyzed and negative margins were found in 70.5% of the lesions, Multivariate analysis showed that non-polypoid morphology, histology of intramucosal cancer + high-grade adenoma and sessile serrated adenoma and polyp were significant factors for incomplete resection. With respect to the difference between lesions ≥10 mm than in those <10 mm, rates of cancer and positive/unclear margins were significantly higher (5.0% vs 0.9%, P < 0.001; 40.6% vs 27.7%, P = 0.007) in the ≥10 mm with rates of postoperative hemorrhage not significantly different (0.8% vs 0.0%). Additionally, the loss of muscularis mucosa was found in 27.8% of all lesions.

Conclusion: CSP is a safe procedure for polyps 2-14 mm. However, CSP has limitations in terms of the histopathological margin and loss of muscularis mucosa in specimens.

Keywords: cold snare polypectomy; colorectal polyp; histopathological margin; large polyps.