BACKGROUND AND AIMS Conventional EMR using a hot snare is the standard of care for resection of large (≥20 mm) nonmalignant sessile colonic polyps. Serious adverse events are predominantly because of electrocautery. This could potentially be avoided by cold snare piecemeal EMR (CSP-EMR). This study aimed to evaluate the safety and efficacy of CSP-EMR of sessile colonic polyps sized ≥20 mm. METHODS All cases of CSP-EMR at 5 Australian academic hospitals for sessile polyps ≥20 mm over a 2-year period, from January 2016 to December 2017, were identified retrospectively. Efficacy was defined as the absence of residual or recurrent polyp tissue during the first surveillance colonoscopy (SC1) and second surveillance colonoscopy (SC2). Clinically significant intraprocedural or delayed adverse events and surveillance colonoscopy findings were assessed by reviewing medical records. RESULTS CSP-EMR was performed on 204 polyps sized ≥20 mm in 186 patients (men, 33.8%; median age, 68 years). SC1 for 164 polyps (80.4%) at a median interval of 150 days showed residual or recurrent polyp in 9 cases (5.5%; 95% confidence interval, 3%-11%). SC2 for 113 polyps (72.9%) at a median interval of 18 months showed late residual or recurrent polyp in 4 cases (3.5%; 95% confidence interval, .9%-8.5%) after a normal SC1. Intraprocedural bleeding was successfully treated in 4 patients (2.2%), whereas 7 patients (3.8%) experienced self-limited clinically significant post-EMR bleeding and 1 patient (.5%) required overnight observation for nonspecific abdominal pain that resolved spontaneously. None experienced other adverse events. CONCLUSIONS CSP-EMR of sessile colonic polyps ≥20 mm is technically feasible, effective, and safe. The adverse event rate and polyp recurrence rate were low. Randomized or large prospective trials are required to confirm the noninferiority and improved safety of CSP-EMR compared with conventional EMR and to further determine the polyp morphologies that are best suited for CSP-EMR.

中文翻译：

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≥20 mm的大型无蒂结肠息肉的冷圈套小肠EMR（带视频）。

背景与目的传统的使用电子圈套器的EMR是切除大（≥20 mm）无恶性无蒂结肠息肉的护理标准。严重的不良事件主要是由于电灼引起的。冷网罗零散EMR（CSP-EMR）可以避免这种情况。本研究旨在评估CSP-EMR对≥20 mm的无蒂结肠息肉的安全性和有效性。方法回顾性分析了2016年1月至2017年12月在澳大利亚的5家学术医院进行的≥20 mm无蒂息肉的所有CSP-EMR病例，历时2年。疗效定义为在第一次监测结肠镜检查（SC1）和第二次监测结肠镜检查（SC2）期间不存在残留或复发性息肉组织。临床重要的过程中或延迟不良事件和监测结肠镜检查结果通过回顾病历进行评估。结果在186例患者中，对204例≥20 mm的息肉进行了CSP-EMR（男性，33.8％；中位年龄，68岁）。SC1的164例息肉（80.4％）的中位间隔为150天，其中9例（5.5％； 95％的置信区间为3％-11％）显示残留或复发性息肉。在中位间隔18个月时，113例息肉的SC2（72.9％）在正常SC1后出现4例（3.5％； 95％置信区间，.9％-8.5％）的晚期残留或复发性息肉。术中出血成功治疗了4例患者（2.2％），而7例患者（3.8％）经历了自限性临床上显着的EMR术后出血，而1例患者（0.5％）需要通宵观察自发缓解的非特异性腹痛。没有人发生其他不良事件。结论≥20 mm的无蒂结肠息肉的CSP-EMR在技术上是可行，有效和安全的。不良事件发生率和息肉复发率较低。需要进行随机或大型前瞻性试验，以证实CSP-EMR与常规EMR相比具有非劣性并提高了安全性，并需要进一步确定最适合CSP-EMR的息肉形态。