Cold resection for colorectal polyps: where we are and where we are going?

ABSTRACT

Introduction

Endoscopic resection of colonic precancerous lesions has been demonstrated to significantly decrease colorectal cancer (CRC) incidence and mortality. Among resection techniques, cold snare polypectomy (CSP) has been shown as a highly feasible, effective and safe option and is widely used in clinical practice, being regarded as the first-line technique for removal of small and diminutive colorectal polyps. On the other hand, conventional hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR), namely the gold standard treatments for larger polyps, may be occasionally associated to complications due to electrocautery injury.

Areas covered

To overcome these shortcomings of electrocautery-based resection techniques, in the last few years CSP has been increasingly assessed as a treatment option for additional indications, with a focus on nonpedunculated colorectal polyps ≥10 mm.

Expert opinion

This review aims to present current and widened indications of CSP discussing the latest findings from the most remarkable studies, with an insight into technical issues, novelties and potential advances in the near future.

KEYWORDS:

• Cold snare resection
• colorectal polyps
• colon cancer
• EMR
• therapeutic endoscopy

Article highlights

• CRC is one of the main leading causes of cancer-related deaths.

• Endoscopic resection of precancerous polyps allows to significantly decrease CRC incidence and mortality.

• CSP is the first-line treatment for small colorectal polyps due to its proven safety and efficacy.

• Hot snare-based polypectomy techniques represent the gold standard option for large colorectal polyps, but electrocautery-related adverse events significantly impair their safety.

• To address these drawbacks of HSP and conventional EMR, over the last few years CSP is being increasingly assessed for expanded indications, such as for large nonpedunculated colorectal polyps.

• New evidence on cold snaring approach from a technical perspective has been very recently carried out to further improve its outcomes.

Declaration of interest

A Repici received a consultancy fee from Olympus, Medtronic, Boston Scientific, ERBE and Fujifilm. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

A Capogreco, L Alfarone and D Massimi performed the research; A Capogreco, L Alfarone and D Massimi wrote the manuscript; A Repici critically reviewed the content of the paper. A Repici supervised the project. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.