Discrepancy between self-reported and actual colonoscopy polypectomy practices for the removal of small polyps

ABSTRACT Background and Aims Cold snare polypectomy (CSP) is associated with higher complete resection rates when compared with cold biopsy forceps (CBF) for the removal of small polyps (4-9 mm). This study aimed to evaluate self-reported polypectomy preferences and actual practice patterns among endoscopists at an academic center and to identify factors associated with the use of CSP for small polyps. Methods In Phase A, endoscopists completed survey evaluating preferences for polypectomy techniques. In Phase B, we performed a retrospective analysis of all consecutive colonoscopies with polypectomy (January 2016 to September 2018). Uni and multivariate analysis (MVA) were performed to identify factors associated with CSP for small polyps. Results Nineteen out of 26 (73%) endoscopists completed the survey (Phase A), of which 3 (15.8%) were interventional endoscopists. Most respondents indicated that they use CSP (89.5%) for small polyps and identified no reasons for choosing CBF over CSP (73.7%). In Phase B, we identified 1118 colonoscopies with 2625 polypectomies for polyps ≤9 mm. Most diminutive polyps (≤3 mm) were removed with CBF (819/912; 90%). For small polyps (n=1713) removal, CBF (46.2%) was also preferentially used, followed by HSP (27.2%) and CSP (26.6%). On MVA, interventional endoscopists were associated with a higher likelihood of using CSP for small polyps (OR, 1.38; 95%CI, 1.07-1.79; p=0.01). Conclusions Significant discrepancy exists between self-reported preferences and actual polypectomy practices. CBF is still preferentially used over CSP for the removal of polyps sized 4-9 mm; further strategies are needed to monitor and implement adequate polypectomy techniques.