This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. Now we have dedicated cold snares, they're all stiff, thin wire snares, 0.25 to 0.3 millimeter diameter, small 10 to 15 millimeter, and most importantly, a semi-rigid snare catheter against which to truncate the polyp. This is a battle that's been fought on a tiny playing field. This is MJB's finger here, and you can see these snares are only a few millimeters wide. So the guideline recommends that cold snare polypectomy to remove diminutive polyps and small polyps, strong recommendation, higher quality evidence, no concerns about that. So you see here a small lesion, very firm downward pressure, aspirate gas, reduce the footprint of the lesion, and then cold snare, slow closure to make sure that the polyp is seated within the snare, and then water jet irrigation. This is a comparison of hot versus cold techniques. They're very different, they're very different. So hot snare, we want to tent the tissue away, speed of transsection is fast, transsection is via diathermy, the protrusion doesn't occur, and interpretation of the defect is difficult. With cold, you want to push down as hard as you can, firm downward pressure, slow closure, sure you have a good margin of tissue, mechanical transsection, probably just in lamina propria most of the time, protrusion is common. You can inspect the defect and you can expand the defect as much as you like. You can make these defects massive. These are the key techniques for complete excision in diminutive polypectomy. We published some time back, there's still a very excellent paper, I think, with a lot of good guidance on how to do things. So we use the stiff wire, flatten the fold, push down very firmly, and excise the lesion. Same again here, you need this halo of normal mucosa. If you have any doubt that you've completely resected the lesion, just keep going. And remember, irrigate the defect with the water jet, invert the edges into the lumen, and you can examine for residual tissue, and also it's very efficient. So you can remove lots of polyps quickly, and if you're using an adult colonoscope, you don't need to remove the snare, anything less than 10mm will come down the channel into the trap, so don't pull the snare out, I never pull the snare out when I'm using an adult colonoscope and I'm doing diminutive polypectomy. It's also very safe, you can do it next to diverticulae or in diverticulae, and this is what we're after, this margin of normal tissue, and then defect expansion after resection is another example. Thank you for watching!

dedicated cold snares

polyp removal

thin wire snares

semi-rigid snare catheter

cold snare polypectomy