Efficacy and safety of cold snare endoscopic mucosal resection of medium to large colorectal adenomas: A retrospective case-control study

Abstract

Background and Aim: Endoscopic mucosal resection (EMR) with a hot snare is a widely accepted and effective therapy for large (greater than 20 mm) laterally spreading lesions in the colon. The cold snare technique provides an alternative method, with reduced rates of bleeding, perforation, and post‐procedure pain. Although there is increasing acceptance of this technique for removal of medium (10–19 mm) and large (≥ 20 mm) serrated lesions, concerns remain about its suitability for the removal of similarly sized adenomas. We aimed to study the safety and efficacy of a cold snare technique, compared with a hot snare technique, for the removal of medium to large adenomas by EMR at our institution.

Methods: Data were collected retrospectively for EMR procedures of Paris 1S and 2A adenomas performed at a single center between 1 February 2018 and 31 August 2019. Provation software was used to source size, morphology, method of resection, and recurrence data. Complications were captured through a review of medical records that included a 1‐month follow‐up phone call.

Results: A total of 100 eligible EMR procedures were performed over the study period (Table 1). All cold EMRs were completed piecemeal, compared with 43% of hot EMRs. Snare tip soft coagulation was used in 47% of hot EMR cases, and 87% of hot EMR defects were prophylactically clipped closed. Eighty patients had completed their 6‐month surveillance colonoscopy (SC1) and 29 their 18‐month surveillance (SC2). The overall recurrence rate at SC1 was higher in the cold EMR group (13.3% vs 2.9%; odds ratio [OR], 5.23; P = 0.13). However, recurrence rates with medium‐sized adenomas appeared to be similar (6.25% vs 7.1%; OR, 0.87; P = 0.92). Endoscopic retreatment of recurrence was successful in all cases. There were no complications reported in the cold EMR group, while the hot EMR group had three cases of clinically significant bleeding, four cases of abdominal pain requiring admission, and one perforation. There were no patients in the cold EMR group who required hospital presentation or admission, whereas patients in the hot EMR group cumulatively required 14 nights in hospital as a result of complications.