Geometry of cold snare polypectomy and risk of incomplete resection

Oliver Cronin; David Kirszenblat; Nauzer Forbes; Sunil Gupta; Anthony Whitfield; Timothy O'Sullivan; Julia Gauci; Muhammad Abuarisha; Hunter Wang; Nicholas G. Burgess; Eric Y.T. Lee; Stephen J. Williams; Michael J. Bourke

doi:10.1055/a-2184-1609

Endoscopy, Table of Contents

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

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

David Kirszenblat

³Department of Mathematics and Statistics, University of Melbourne, Parkville, Australia

,

Nauzer Forbes

⁴Medicine, University of Calgary, Calgary, Canada

,

Sunil Gupta

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Anthony Whitfield

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Timothy O'Sullivan

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Julia Gauci

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Muhammad Abuarisha

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Hunter Wang

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Nicholas G. Burgess

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Eric Y.T. Lee

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Stephen J. Williams

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

,

Michael J. Bourke

¹Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia (Ringgold ID: RIN8539)

²Medicine, University of Sydney Westmead Clinical School, Sydney, Australia

› Author Affiliations

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.

Full Text

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Supplementary Material

Supplementary material