Post written by Yuichi Shimodate, MD, from the Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan.

We compared the complete resection, which was defined if muscularis mucosa in the resected specimen was present under the tumor along more than 80% of the tumor’s horizontal dimension, rates of cold snare polypectomy with submucosal saline injection (CSP-SI) with that of conventional CSP (C-CSP) as a single-center, prospective, randomized, open-label trial.

Cold snare polypectomy is a widely accepted procedure for small colorectal polyps. However, this technique is still troubled with insufficient resection depth, which may prevent precise pathological evaluation. So, we needed to improve the quality of resected specimens for appropriate histological evaluation.

The rate of complete muscularis mucosa resection was 43.9% in the CSP-SI group and 53.3% in the C-CSP group, which was statistically insignificant, indicating the submucosal injection did not improve the quality of resected specimens of CSP in terms of resection depths. Additionally, the rates of negative lateral and vertical margin in the CSP-SI group were significantly lower than those in the C-CSP group. For safety, there was no polypectomy-related major bleeding or perforation.

Considering these findings, in addition to the expense and time that saline injection imposes, the technique cannot be recommended for the removal of small colorectal polyps with CSP. Better methods are needed to achieve sufficiently deep resection in CSP, and improvement of polypectomy snare may also be necessary for enabling the easy grasp of lesions together with the submucosal layer.

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