LAUSR

BACKGROUND AND AIMS Conventional endoscopic mucosal resection (EMR) using hot snare is the standard of care for resection of large (≥20 mm) nonmalignant sessile colonic polyps. Serious adverse events are predominantly due to electrocautery. This could potentially be avoided by cold snare piecemeal EMR (CSP-EMR). The study aimed to evaluate the safety and efficacy of CSP-EMR of sessile colonic polyps sized ≥20 mm. METHODS All cases of CSP-EMR at 5 Australian academic hospitals for sessile polyps ≥20 mm over a 2-year period, from January 2016 to December 2017 were identified retrospectively. Efficacy was defined as the absence of residual or recurrent polyp tissue during the first surveillance colonoscopy (SC1) and second surveillance colonoscopy (SC2). Clinically significant intraprocedural or delayed adverse events and surveillance colonoscopy findings were assessed by reviewing medical records. RESULTS CSP-EMR was performed on 204 polyps sized ≥20 mm in 186 patients (men 33.8%; median age 68 years). SC1 for 164 (80.4%) polyps at a median interval of 150 days showed residual or recurrent polyp in 9 cases (5.5%; 95% CI, 3%-11%). SC2 for 113 (72.9%) polyps at a median interval of 18 months showed late residual or recurrent polyp in 4 cases (3.5%; 95% CI, 0.9%-8.5%) after a normal SC1. Intra-procedural bleeding was successfully treated in 4 (2.2%) patients, 7 (3.8%) patients experienced self-limiting clinically significant post-EMR bleeding (CSPEB) and 1 patient (0.5%) required overnight observation for nonspecific abdominal pain that resolved spontaneously. None experienced other adverse events. CONCLUSION CSP-EMR of sessile colonic polyps ≥20 mm is technically feasible, effective, and safe. The adverse event rate and polyp recurrence rate were low. Randomized or large prospective trials are required to confirm the noninferiority and improved safety of CSP-EMR compared with conventional EMR, and to further determine the polyp morphologies that are best suited for CSP-EMR.