Cold snare polypectomy effective for large colon polyps of 1-2 cm

Professor Kim Hyun-gun (Credit: Soonchunhyang University Seoul Hospital)

Cold snare polypectomy, which has been limited to small colorectal polyps less than 1 cm in size, has been shown to be an optimal treatment that is safe and fully applicable to polyps between 1 and 2 cm in size, a Korean gastroenterologist said.

Cold snare polypectomy refers to ablating polyps using a thin noose, which is designed not to be electrically energized. It significantly lowers bleeding and perforation complications compared to conventional electrically energized methods.

Soonchunhyang University Seoul Hospital said Professor Kim Hyun-gun of the Department of Gastroenterology presented his study at Digestive Disease Week in Chicago, the U.S., on Tuesday last week.

Digestive Disease Week is the world's largest medical conference held annually in the U.S.

During the event, the American Society for Gastrointestinal Endoscopy (ASGE) holds a joint session with the Korean Society of Gastrointestinal Endoscopy (KSGE) every two years.

Professor Kim was a speaker for KSGE and gave a talk on "Optimal Endoscopic Treatment for Colorectal Polyps of 1-2 cm in Size” in the session, “Current Advances in Endoscopic Diagnosis and Treatment of Colorectal Tumors," co-sponsored by ASGE and KSGE.

Through analysis of clinical data from 1,028 colorectal polyps removed from 419 patients who visited the Department of Gastroenterology at Soonchunhyang University Seoul Hospital between 2015 and 2020, as well as analysis of existing studies, Kim explained that cold snare polypectomy, which has been limited to colorectal polyps smaller than 1 cm, was the best surgical technique that can be safely and completely applied to polyps of 1 to 2 cm in size.

Cold snare polypectomy, which involves a shallower ablation than conventional polypectomy, has been perceived to be less effective in treating colorectal polyps larger than 1 cm in size due to the higher likelihood of cancer development.

However, Kim said if cancerous changes are accurately excluded using image-enhanced endoscopy, cold snare polypectomy can be performed on colorectal polyps of 1 to 2 cm in size to minimize complications such as bleeding and intestinal perforation.

In particular, he emphasized that low-temperature mucosal resection is a beneficial procedure for removing relatively large lesions of 1.5 to 2 cm in size, as the boundaries of the lesion can be accurately identified and the lesion can be removed entirely without residual lesions.