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Endoscopy 2024; 56(03): 214-219
DOI: 10.1055/a-2184-1609
Innovations and brief communications

Geometry of cold snare polypectomy and risk of incomplete resection

Oliver Cronin
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
David Kirszenblat
3   Department of Mathematics and Statistics, University of Melbourne, Parkville, Australia
,
Nauzer Forbes 
4   Medicine, University of Calgary, Calgary, Canada
,
Sunil Gupta 
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Anthony Whitfield
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Timothy O'Sullivan
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Julia Gauci
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Muhammad Abuarisha
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Hunter Wang
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Nicholas G. Burgess 
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Eric Y.T. Lee
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Stephen J. Williams
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
,
Michael J. Bourke
1   Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)
2   Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
› Author AffiliationsThe Cancer Institute of New South Wales
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Abstract

Background Cold snare polypectomy (CSP) is safer than and equally efficacious as hot snare polypectomy (HSP) for the removal of small (<10mm) colorectal polyps. The maximum polyp size that can be effectively managed by piecemeal CSP (p-CSP) without an excessive burden of recurrence is unknown.

Methods Resection error risks (RERs), defined as the estimated likelihood of incomplete removal of adenomatous tissue for a single snare resection pass, for CSP and HSP were calculated, based on an incomplete resection rate. Polyp area, snare size, estimated number of resections, and optimal resection defect area were modeled. Overall risk of incomplete resection (RIR) was defined as RIR=1 – (1 – p)n, where p is the RER and n the number of resections.

Results A 40-mm polyp has a four times greater area than a 20-mm polyp (314.16mm2 vs. 1256.64mm2), and requires three times more resections (11 vs. 33, respectively, assuming 8-mm piecemeal resection pieces for p-CSP). RIRs for a 40-mm polyp by HSP and p-CSP were 15.1%–23% and 40.74%–60.60% respectively.

Conclusion RER is more important with p-CSP than with HSP. The number of resections, n, and consequently RIR increases with increasing polyp size. Given the overwhelming safety of CSP, specific techniques to minimize the RER should be studied and developed.

Supplementary Material



Publication History

Received: 28 March 2023

Accepted after revision: 29 September 2023

Accepted Manuscript online:
29 September 2023

Article published online:
17 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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