Cold snare resection of a nonpolypoid lesion >45 mm

Monteverde_headshotRoberto Augusto Barros, MD and María José Monteverde, MD from the Department of Digestive Endoscopy, Ambulatory Gastroenterology Center (CEGA), in Campana, Buenos Aires, Argentina share this video case “Cold snare resection of a nonpolypoid lesion >45 mm.”

We show a a cold snare mucosectomy of a non granular laterally spreading tumor (LST) larger than 45 mm, located in the 83 years old patient’s ascendant colon. We used a piecemeal technique with wide margins resection to improve efficiency. There were no immediate or late adverse events. The 3-months endoscopic follow up with biopsy of the complete scar showed an efficient treatment taking into account the lesion size.

Although ESD, EMR with piecemeal, and right hemicolectomy were the treatment options, the team decided at diagnosis time to resect with cold snare because it was considered to be the safest for the patient. A specific snare designed for cold resections was used, and a ruled technique was implemented, which has been part of our daily practice for the last 5 years. This technique is described in the video. It implies a learning curve, since it is different from resections with electrocautery; it can be considered safe, as we have reported in our original manuscript “Safety and efficacy of cold snare resection of non-polypoid colorectal lesions (0-IIa and 0-IIb) of up to 20 mm” (Acta Gastroenterol Latinoam 2014; 44:27-32).

This may be the maximum expression of cold resection of a colonic non-polypoid lesion. However, this video has the sole intention of showing that the technique, when properly applied, could be part of the therapeutic options for non-polypoid colorectal lesions, even for larger ones.

ESD, EMR with or without piecemeal, and conventional polypectomy have complications related to electrocautery use, with efficiency rates still unsatisfactory for this type of lesions. However, the most frequently found non-polypoid lesions (between 6 and 10 mm size), are currently resected by means of electrocautery almost everywhere.

Considering cold snare for performing mucosae resections may motivate future research protocols, and also the development of new endotherapy material that could contribute to enhance the technique.

An endoscopist should aim to find a safe, efficient, replicable, rapid and inexpensive technique. We invite other groups interested in this issue to join us in this direction.

Perhaps, we could start challenging the current paradigm of electrocautery application in many of colonic non polypoid lesions.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

3 thoughts on “Cold snare resection of a nonpolypoid lesion >45 mm

    1. Roberto Augusto Barros

      We consider that this technique is safe for non polypoid lesions of any size, only if it is performed in a ruled way and with specific endotherapy materias. We suggest you to read the article is named in the post.
      This technique requires a learning curve, it is very important to start working with small lesions Once you get the ability, you could use this technique in larger lesions.

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