UNDERWATER COLD SNARE POLYPECTOMY FOR IMPROVING OF COMPLETE RESECTION RATE AND RETRIEVAL RATE IN SMALL COLORECTAL POLYPS

Aims Cold snare polypectomy (CSP) has been reported as safe and effective method for the removal of small colorectal polyps. However, some studies showed low histologic complete resection rate due to damage to specimens retrieved via suction and high retrieval failure. Underwater endoscopic mucosal resection (EMR) is an effective technique to increase the proportions of complete resection without increasing adverse events or procedure time. Therefore, the aim of this study was to compare the complete resection rate and retrieval rate between conventional CSP (C-CSP) and underwater CSP (U-SCP).

Methods This study was a prospective randomized controlled trial. A total of 103 small polyps (< 10mm) in 58 patients were enrolled between March 2019 and September 2019. The polyps were randomized to be treated with either C-CSP (51 polyps) or U-CSP (52 polyps). Primary outcome was the rate of histologic complete resection.

Results Among the 103 polyps, the rate of histologic complete resection was significantly higher in U-CSP group than in C-CSP groups (84.6% vs 55.3%; p = 0.002). The rate of polyp retrieval failure was 7.8 % in C-CSP and 0 % in U-CSP (p = 0.057). The rate of polyp fragmentation of C-CSP and U-CSP group was 8.5% and 0% (p = 0.047). The procedure time and retrieval time were longer in C-CSP than U-CSP (55.17 ± 47.69 vs 36.63 ± 22.70; p = 0.026 and 63.61 ± 47.69 vs 14.48 ± 15.75; p < 0.001). No clinically significant postprocedural bleeding or perforation occurred in either group.

Conclusions The results of this study were excellent with U-CSP of small colorectal polyps < 10mm in terms of complete resection, polyp retrieval and fragmentation rate, and procedure/retrieval time. Therefore, we can consider the U-CSP as a valuable modification of the C-CSP for resecting small colorectal polyps