Ferdinande K, Desomer L, De Looze D, Tate D J
Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.
Department of Gastroenterology and Hepatology, AZ Delta Rumbeke, Rumbeke, Belgium.
Acta Gastroenterol Belg. 2024 Oct-Dec;87(4):505-516. doi: 10.51821/87.4.13199.
Colorectal cancer (CRC) is the second and third leading cause of cancer death in men and women respectively worldwide. Colonoscopy is the gold standard screening test to detect premalignant lesions with endoscopic polypectomy preventing evolution to CRC. Endoscopic polypectomy is effective with a higher safety profile and is less costly as compared to surgery. Bestpractice polypectomy technique is crucial, as 10% of polyps <2 cm are incompletely resected and may therefore play a significant role in the development of post colonoscopy colorectal cancer (PCCRC). Hot snare polypectomy (HSP) has traditionally been the technique of choice for endoscopic polypectomy but is associated with a small but appreciable risk of adverse events, primarily postpolypectomy bleeding and perforation. Recent high-quality studies have demonstrated the similar efficacy and superior safety profile of cold snare polypectomy (CSP) for polyps less than 10 mm in size. In daily clinical practice, the vast majority of colorectal polyps encountered by gastroenterologists are less than 10 mm, making CSP the technique of choice. Widespread use of CSP over HSP may therefore significantly reduce the number of adverse events associated with endoscopic polypectomy. The indication for CSP may be extended to larger lesions, including large, non-dysplastic sessile serrated lesions and small pedunculated polyps with a thin stalk. In addition, the risk-benefit ratio of CSP is favourable in patients in whom interruption of anticoagulants is a concern in terms of thromboembolic risk. In this review, the focus will be on safety of hot versus cold snare polypectomy as a technique for the resection of diminutive and small polyps.
结直肠癌（CRC）分别是全球男性和女性癌症死亡的第二和第三大主要原因。结肠镜检查是检测癌前病变的金标准筛查方法，通过内镜下息肉切除术可预防其发展为结直肠癌。与手术相比，内镜下息肉切除术效果良好，安全性更高，成本更低。最佳实践息肉切除技术至关重要，因为小于2厘米的息肉中有10%切除不完全，因此可能在结肠镜检查后结直肠癌（PCCRC）的发生中起重要作用。传统上，热圈套息肉切除术（HSP）一直是内镜下息肉切除术的首选技术，但它与较小但明显的不良事件风险相关，主要是息肉切除术后出血和穿孔。最近的高质量研究表明，对于大小小于10毫米的息肉，冷圈套息肉切除术（CSP）具有相似的疗效和更高的安全性。在日常临床实践中，胃肠病学家遇到的绝大多数结直肠息肉小于10毫米，这使得CSP成为首选技术。因此，广泛使用CSP而非HSP可能会显著减少与内镜下息肉切除术相关的不良事件数量。CSP的适应证可能扩展到更大的病变，包括大的、无发育异常的广基锯齿状病变和蒂细的小带蒂息肉。此外，对于那些担心抗凝剂中断会带来血栓栓塞风险的患者，CSP的风险效益比是有利的。在本综述中，重点将放在热圈套与冷圈套息肉切除术作为切除微小和小息肉技术的安全性上。
