Submucosal Injection Unnecessary for 3- to 9-mm Polyps, per Randomized Controlled Trial Results
Douglas K. Rex, MD, MASGE, reviewing Mou Y, et al. Am J Gastroenterol 2023 May 19.
Cold snare resection is the treatment of choice for 4- to 9-mm polyps, yet some practitioners perform submucosal injection for polyps in this size range.
In a randomized controlled trial performed in 6 Chinese centers, 150 patients with 234 polyps, ranging in size from 3 to 9 mm, were randomly assigned to receive submucosal injection followed by cold snare polypectomy and compared with 150 patients with 216 polyps randomized to simple cold snare polypectomy.
After each resection, the site was washed and then inspected with narrow-band imaging. If any polyp tissue was suspected, a targeted biopsy was performed.
The incomplete resection rate was 1.7% in the injection group versus 1.4% without injection. Procedure time was longer with injection (108 vs 48 seconds; P<.001). There were no differences between arms in immediate or delayed bleeding.
COMMENTThis study should put to rest the idea of any benefit from routine submucosal injection of polyps <10 mm. The only reason to inject such lesions is the rare case in which endoscopic findings suggest the possibility of cancer. I suspect that we will eventually draw similar conclusions for the great majority of 10- to 20-mm lesions, but additional study is needed.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Mou Y, Ye L, Qin X, et al. Impact of submucosal saline injection during cold snare polypectomy for colorectal polyps sized 3-9 mm: a multicenter randomized controlled trial. Am J Gastroenterol 2023 May 19. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002329)
