Original Article
Colon polyp retrieval after cold snaring

https://doi.org/10.1016/S0016-5107(05)00376-7Get rights and content

Background

The removal of small colon polyps by cold snare transection without electrocautery effectively eliminates polyps, and anecdotal reports indicate a low risk of bleeding and perforation. Concerns about using cold snaring have centered on the risk of immediate bleeding and the difficulty in retrieving the polyp. The objective was to determine the retrieval rates of polyps after cold snaring after two different methods of resection and retrieval.

Methods

Consecutive polyps were identified by a single colonoscopist who chose the technique of polypectomy (hot snare, cold snare, or cold forceps). If cold snaring was chosen, an independent observer assigned the polyp to method A (cold resection of polyp without tenting and then suction of the transected polyp into a trap) or method B (ensnare the polyp, pull it into the colonoscope channel, and then transect it while suctioning). The size and the approximate location of all polyps were recorded and all collected specimens were sent separately for histologic examination.

Results

Of 519 consecutively encountered polyps, 400 were removed by cold snare: 197 were assigned to method A and 203 to method B. The mean size of polyps that were cold snared was 3.5 mm. The mean time to remove and to retrieve polyps with method A was 14.5 seconds (n = 58) and with method B was 18.1 seconds (n = 60) (p = 0.03). There were no complications from cold snaring. The rate of successful retrieval with method A was 100% (197 of 197 polyps) and with method B was 98% (199 of 203 polyps) (p = 0.04).

Conclusions

Cold snare removal of colon polyps is associated with a high polyp retrieval rate. Each of two methods of polyp retrieval was effective. Snare transection without tenting of the polyp, followed by suctioning of the specimen off the polyp site, was more efficient, though the difference in efficiency was minimal. Difficulty or failure to retrieve polyps should not be a concern with regard to cold snare polypectomy.

Section snippets

Patients and methods

The study was approved by the Institutional Review Board at Indiana University Purdue University Indianapolis/Clarian Health Partners.

A total of 519 consecutive polyps were identified by a single experienced colonoscopist (D.K.R.), who performed polypectomy with hot snare, cold snare, or cold forceps. The study colonoscopist does not use hot forceps for polypectomy. A total of 400 polyps were selected for cold snaring, based on their size and shape. The study colonoscopist typically uses cold

Results

A total of 519 consecutive polyps in 167 patients were resected during the study interval, with 400 polyps (77%) removed by cold snare. The estimated locations and pathologic findings of the 400 polyps removed by cold snaring are shown in Table 1. Of the polyps transected by cold snare, those removed by method A had a mean size of 3.7 mm, and the polyps removed by method B had a mean size of 3.4 mm (p = 0.16). No complications were observed with cold snare transection. Of the 119 polyps removed

Discussion

In this study, we evaluated two different methods of resecting and retrieving polyps with cold snare resection. Both methods were highly effective for polyp retrieval. One method consisted of snare resection without tenting the polyp, followed by suctioning the polyp (by moving the suction channel up to the polyp as it is seen in the endoscopic field), and was a more efficient method of polypectomy. The explanation for the superiority of this method appears to be that the polyp sticks to the

References (29)

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