ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-21_Shami

21_Shami_Cold snare polypectomy

Pdf Summary

"Cold snare polypectomy" is discussed by Dr. Vanessa M. Shami as a preferable technique for polyp removal due to its cost savings and reduced risk of complications like bleeding and perforation. The "cold revolution" refers to this method's advantage over traditional electrocautery, eliminating the need for an electrosurgical generator and closure devices.<br /><br />The technique is generally recommended for nonpedunculated polyps under 10mm, irrespective of the setting, including serrated lesions. Larger polyps, up to 19mm, can be considered for cold snare resection, but factors such as location and patient risk must be evaluated.<br /><br />During the procedure, a key step is the assessment of lesions to determine suitability for cold snaring. Successful resection minimizes recurrence risk, but proper technique, including the use of cold-specific snares and careful inspection of resection margins, is crucial.<br /><br />The presentation highlights that despite cold snare's efficacy and safety, specific conditions such as fibrous or bulky pedunculated adenomatous lesions may still require traditional hot snare techniques or additional closure steps. Ongoing research aims to address optimal methods for larger polyps and assess long-term outcomes like recurrence rates.<br /><br />Key considerations include ensuring the right tools, like stiff snares for flat lesions and appropriate injection techniques, are used. No thermal therapy or clips are generally needed for cold snare polypectomy. It's particularly recommended for sessile serrated polyps (SSPs) unless high-risk features suggest otherwise.<br /><br />Ultimately, cold snare polypectomy is favored for its reduced complication rates compared to hot snare and is currently the subject of numerous ongoing trials exploring its long-term efficacy and safety.

Keywords

cold snare polypectomy

polyp removal

cost savings

reduced complications

nonpedunculated polyps

cold revolution

resection margins

sessile serrated polyps

electrocautery alternative

ongoing trials