In the August 2023 issue of The American Journal of Gastroenterology, Muhammad Alsayid, MD, MPH, MS, an academic gastroenterologist at RUSH University Medical Center, and his fellow authors presented the results of their research evaluating the effectiveness of two polypectomy techniques — cold snare and cold forceps — when removing colorectal polyps.
In their study, Dr. Alsayid and his colleagues report that cold snare polypectomy is recommended in the removal of diminutive (<6 mm in size) and small (6-9 mm) colorectal polyps. Although forceps can allow for greater stability during polypectomy, a polyp’s location and shape and the resection technique can limit the physician’s ability to achieve a complete resection.
“If you’re removing the polyp with forceps alone, you can expect between a 20 to 30% incomplete resection rate,” Dr. Alsayid says. “The use of the snare allows for complete resection around the tissue, thus resulting in significantly higher success rates for reducing small adenoma recurrence.”
Incomplete resection of colorectal polyps has been responsible for up to 30% of interval colorectal cancers. Thus, finding ways to achieve complete resection would help reduce that rate.
The use of cold snare in removing diminutive (<6 mm) polyps reduced the segmental incomplete rate (S-IRR) from 13% when using a cold forceps to 0%. In addition, using a cold forceps in removing small polyps (6-9 mm) increased the risk of adenoma recurrence by more than threefold compared to using a cold snare. Dr. Alsayid and fellow authors consider these rates aspirational targets for all physicians who perform colonoscopy.
Dr. Alysaid recommends that future studies explore the use of S-IRR monitoring and whether education for gastroenterologists on resection techniques and providing feedback on segmental recurrence could reduce recurrence rates and improve patient outcomes.
To learn more, read Dr. Alsayid’s article here.