Efficacy and safety of cold-snare endoscopic mucosal resection for colorectal adenomas 10 to 14 mm in size: a prospective observational study

      Background and Aims

      Cold-snare endoscopic mucosal resection (CS-EMR) has been adapted in a piecemeal fashion as a safe and effective procedure for resection of colorectal polyps ≥10 mm. However, few data are available on en bloc CS-EMR for adenomas of 10 to 14 mm. Thus, this study evaluated the efficacy and safety of CS-EMR for these colorectal adenomas.


      In this single-arm, prospective, observational study, patients with at least 1 slightly elevated and sessile colorectal adenoma measuring 10 to 14 mm were recruited to undergo CS-EMR. The primary outcome was histological complete resection rate by CS-EMR, which was defined as en bloc resection, with a pathologically negative vertical margin and no neoplastic tissue obtained from 4 quadrants of the mucosal defect margin. Secondary outcomes were en bloc resection rate by CS-EMR, failure rate of CS-EMR, and the incidence of adverse events.


      A total of 80 polyps from 72 patients were included. CS-EMR failed in 11 lesions (13.7%), all of which were resected using a high-frequency electric current. The rates of en bloc resection and histologic complete resection by CS-EMR were 82.5% (66 of 80) and 63.8% (51 of 80), respectively. No bleeding occurred during the CS-EMR procedure, and there was no delayed bleeding or perforation at the site where CS-EMR was performed.


      CS-EMR can be safely performed in an en bloc fashion for some colorectal adenomas measuring 10 to 14 mm. However, there is room for improvement regarding the resectability and evaluation of the vertical margin after CS-EMR. (Clinical trial registration number: UMIN000031248.)

      Graphical abstract


      CS-EMR (cold-snare endoscopic mucosal resection), CSP (cold-snare polypectomy), HS-EMR (hot snare endoscopic mucosal resection), HSP (hot snare polypectomy), IQR (interquartile range)
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      Linked Article

      • Cool it now: a new addition for resecting 10- to 14-mm polyps
        Gastrointestinal EndoscopyVol. 92Issue 6
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          In this month’s Gastrointestinal Endoscopy, Yabuuchi et al1 present their prospective data on the safety and efficacy of cold snare EMR of polyps measuring 10 to 14 mm. The authors use a rigorous standard of “histologic complete resection,” defined by visual en bloc resection, a pathologically negative vertical margin, and no neoplastic tissue in 4-quadrant biopsy specimens taken around the resection margin. This leads to some illuminating data, and there are lessons to learn from the results. But let’s first ask an important question.
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