Cold snare polypectomy is a safe and effective technique to remove large, partially circumferenctial duodenal polyps.
Vance RB, and Piraka C. Cold snare polypectomy is a safe and effective technique to remove large, partially circumferenctial duodenal polyps. Gastroint Endosc 2017; 85(5):AB295.
Introduction: Large duodenal polyps, specifically, those greater than 50% luminal circumference are often removed with endoscopic snare cautery, or sometimes surgically. Snare cautery can lead to thermal injury to the duodenal wall, delayed bleeding and perforation and surgical management can lead to significant morbidity. Cold snare polypectomy has been shown to be a safe and effective technique for colon adenomas over 1 centimeter but whether that translates to large adenomas of the duodenum is not clear. Aim: Our aim was to evaluate the efficacy and safety of cold snare technique for large duodenal polyps. Methods: We retrospectively reviewed the charts of all patients undergoing lift and piecemeal cold snare polypectomies by a single endoscopist for duodenal polyps greater than 5 millimeters in size from 2014-2016. Primary endpoints included residual polyp at subsequent endoscopy. Secondary endpoints were number of endoscopies required for polyp eradication, and complication rate. Endpoints were then compared in the greater than and less than 50% circumferential polyps. Results: 19 patients, average age 66.7 years (37% men) underwent lift then piecemeal cold snare polypectomy of 21 polyps. Average polyp size was 29.4 millimeters, with 37% of the polyps taking up over 50% of the luminal circumference. The polyps were most often located at the second portion of the duodenum (47%) with an average of 1.89 endoscopies required to completely eradicate the polyps. Residual polyp was present on subsequent endoscopies in 9 (47%) of all patients, with 5 (56%) of those coming from patients with polyps greater than 50% luminal circumference. The polyps greater than 50% luminal circumference were significantly larger (p<0.005), more often had a villous component or high-grade dysplasia (p=0.09) and required more endoscopies for eradication (2.6 vs 1.6, p=0.08). Four patients(21%) developed strictures, three of those coming from the greater than 50% luminal circumference polyps. Notably, there were no perforations and none of the patients required surgery. There was one post-polypectomy bleed (5%); it was immediate and treated with hemoclips. There was no delayed post-polypectomy bleeding. Argon plasma coagulation (APC) was more often used during resections of the greater than 50% circumferential polyps (43% vs 8%, p<0.05). Conclusion: In our small sample, cold snare lift then piecemeal polypectomy is safe and effective at removing duodenal polyps both greater than and less than 50% luminal circumference. (Table Presented).