Polypectomy of Small Polyps – ESGE Guideline Recommends Cold Snare Polypectomy (CSP)

Jochen Weigt, Magdeburg

Since 2017, ESGE guidelines require that a standard snare should no longer be used for the removal of small polyps, and especially diminutive polyps (Endoscopy 2017; 49 (03):270–297). The reason for this is the relatively low rate of safe R0 resections and the simultaneously low adherence to follow-up care guidelines

The current recommendation is to remove such polyps with a cold snare. Until a few years ago, there were hardly any snares produced for the specific purpose of cold polypectomy. Now there are numerous suppliers on the market, such as MicroTech, Medwork, and Boston.

The complication rates of CSP are generally very low because diathermy effects, such as postpolypectomy syndrome, are not relevant. In the polypectomy site, small stalks can be seen. Although often mistakenly considered or reported as vessels, these visible stumps are composed of submucosa and lamina muscularis mucosae.

Although polyps up to circa 10–12 mm can be removed cold without any problems, it is advisable to consider using hybrid snares that allow polyp removal with or without diathermy. Therefore, one instrument can be used to remove larger and smaller polyps.

Figure 1: Polyp less than 10 mm in colon

Figure 2: Positioning the cold snare

Figure 3: Grasping the polyp with safety margin

Figure 4: Resection site after polyp removal with typical, small central stalk