Cold versus hot polypectomy/endoscopic mucosal resection-A review of current evidence.

Abstract

BACKGROUND:

Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection.

AIM:

The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy.

RESULTS:

Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post-polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5-18%. Lower recurrence rates are found in serrated lesions (<8%).

• Authors: Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
• Journal: United European gastroenterology journal (United European Gastroenterol J) Vol. 9 Issue 8 Pg. 938-946 (10 2021) ISSN: 2050-6414 [Electronic] England
• PMID: 34355525 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: © 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.

Topics

• Colonic Polyps (pathology, surgery)
• Colonoscopy (methods)
• Colorectal Neoplasms (pathology, surgery)
• Cryosurgery (methods)
• Electrocoagulation (adverse effects)
• Endoscopic Mucosal Resection (methods)
• Hemorrhage (etiology)
• Humans
• Intestinal Perforation (etiology)
• Patient Safety
• Postoperative Complications (etiology)