A Comparison of Incomplete Resection Rate of Large and Small Colorectal Polyps by Cold Snare Polypectomy.

ABSTRACT Background & Aims There are limited data regarding the safety and efficacy of cold snare polypectomy (CSP) for large colorectal polyps. We evaluated factors affecting the clinical outcomes of CSP for polyps between 5 and 15 mm in size. Methods This was a prospective single-center observational study involving 1000 patients undergoing colonoscopy. Polyps (5-15 mm) were removed using CSP, and biopsies were taken from the resection margin. The primary outcome was the incomplete resection rate (IRR), and was determined by the presence of residual neoplasia on biopsy. Correlations between IRR and polyp size, morphology, histology, resection time were assessed by generalized estimating equation (GEE) model. Results A total of 440 neoplastic polyps were removed from 261 patients. The overall IRR was 2.27%, 1.98% for small (5-9 mm) vs 3.45% for large (10-15 mm) polyps, P=0.411). In univariate analysis, the IRR was more likely to be related to SSL (OR=6.93, 95% CI 1.88-25.45, P=0.004), piecemeal resection (OR=11.83, 95% CI 1.20-116.49, P=0.034) and prolonged resection time >60s (OR=7.56, 95% CI 1.75-32.69, P=0.007). In multivariable regression analysis, SSL (OR=6.45, 95% CI 1.48-28.03, P=0.013) and resection time (OR=7.39, 95% CI 1.48-36.96, P=0.015, respectively) were independent risk factors for IRR. Immediate bleeding was more frequent with resection of large polyps (6.90% vs 1.42%, P=0.003). No recurrence was seen on follow-up colonoscopy in 37 cases with large polyps. Conclusions CSP is safe and effective for removal of colorectal polyps up to 15 mm in size, with a low IRR.