The following is a summary of “Impact of Cold Snare vs Cold Forceps Resection of Diminutive Adenomas on Segmental Incomplete Resection Rate,” published in the August 2023 issue of Gastroenterology by Van, et al.
The technique used for polypectomy, either cold snare polypectomy (CSP) or cold forceps polypectomy (CFP), varies among colonoscopists when resecting diminutive lesions. While it was established that CSP is a preferred method for resecting small lesions, limited data existed regarding the impact of these resection techniques on the burden of metachronous adenomas. For a study, researchers sought to assess the rate of incomplete resection attributable to CSP and CFP in cases of diminutive adenomas.
A retrospective cohort study was conducted across two centers to evaluate the segmental incomplete resection rate (S-IRR) of diminutive tubular adenomas (TA). S-IRR was calculated by comparing the metachronous adenoma rate in colonic segments without adenoma to segments with adenoma on the initial colonoscopy. The primary outcome was the S-IRR of diminutive TA resected using CSP or CFP during the initial colonoscopy.
A total of 1,504 patients were analyzed, including 1,235 with TA <6 mm and 269 with TA 6–9 mm as the most advanced lesion. The S-IRR for segments with <6-mm TA incompletely resected using CFP during the initial colonoscopy was 13%. In contrast, the S-IRR for segments with <6-mm TA incompletely resected using CSP was 0%. Among the 12 participating colonoscopists, the overall S-IRR ranged from 1.1% to 24.4%, with an average S-IRR of 10.3%.
CFP resection of diminutive TA resulted in a 13% higher S-IRR than CSP. A suggested S-IRR benchmark of <5% is a target goal for all diminutive polyp resections, given that 3 out of the 12 colonoscopists achieved this low rate. S-IRR can be useful for comparing and quantifying differences in segmental metachronous adenoma burden across various polypectomy techniques.