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Underwater versus conventional cold snare polypectomy of colorectal polyps 4–9 mm in diameter: a prospective randomized controlled trial

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Abstract

Background and 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 R0 resection rate. Underwater endoscopic mucosal resection is an effective technique to increase the proportions of complete resection. Therefore, the aim was to compare the rate of R0 resection of colorectal polyps 4–9 mm in diameter between conventional CSP (C-CSP) and underwater CSP (U-CSP).

Methods

This study was a prospective randomized controlled trial. A total of 198 polyps (4–9 mm) in 110 patients were enrolled between December 2019 and June 2020. The polyps were randomized to be treated with either C-CSP (100 polyps) or U-CSP (98 polyps).

Results

The R0 resection rate was significantly higher in U-CSP group than in C-CSP groups (84.7% vs. 59.0%; p < 0.001). The polyp retrieval rate of C-CSP and U-CSP was 94.5% and 100% (p = 0.030). The rate of polyp fragmentation of C-CSP and U-CSP group was 5.3% and 0% (p = 0.027). The resection time and retrieval time were longer in C-CSP than U-CSP (45.0 ± 37.7 s vs. 34.1 ± 21.2 s, p = 0.032 and 51.9 ± 67.7 s vs. 12.7 ± 12.4 s, p < 0.001). No clinically significant bleeding or perforation occurred in either group.

Conclusions

The results of this study were excellent with U-CSP of 4–9 mm colorectal polyps in terms of R0 resection, polyp retrieval and fragmentation rate, and procedure/retrieval time. Therefore, U-CSP is a safe and effective technique for removing colorectal polyps 4–9 mm in diameter. KCT (0004530).

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Abbreviations

CSP:

Cold snare polypectomy

C-CSP:

Conventional cold snare polypectomy

U-CSP:

Underwater cold snare polypectomy

HSP:

Hot snare polypectomy

EMR:

Endoscopic mucosal resection

NBI:

Narrow-band imaging

U-EMR:

Underwater endoscopic mucosal resection

EUS:

Endoscopic ultrasound

SSPs:

Sessile-serrated polyps

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Authors and Affiliations

  1. Gastroenterology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea

    Yu Sik Myung, Hyuki Kwon, Jaeho Han, Jongreul Lim, Soo Yong Choi, Myong Ki Baeg & Sok Won Han

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  1. Yu Sik Myung
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  2. Hyuki Kwon
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  4. Jongreul Lim
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Contributions

All authors helped to perform the research. YSM: writing of the manuscript and performing cold snare polypectomy; HIK, JRL: collecting data; HJH: collecting data and performing cold snare polypectomy; SYC: collecting date and performing statistical analysis; MKB, SWH: review the manuscript. All authors agreed the final content of the manuscript.

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Correspondence to Yu Sik Myung.

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Disclosures

Drs. Yu Sik Myung, Hyuki Kwon, Jaeho Han, Jongreul Lim, Soo Yong Choi, Myong Ki Baeg, and Sok Won Han have no conflicts of interest or financial ties to disclose.

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Myung, Y.S., Kwon, H., Han, J. et al. Underwater versus conventional cold snare polypectomy of colorectal polyps 4–9 mm in diameter: a prospective randomized controlled trial. Surg Endosc 36, 6527–6534 (2022). https://doi.org/10.1007/s00464-022-09013-3

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