Clin Endosc.  2025 Mar;58(2):291-302. 10.5946/ce.2024.113.

Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial

• Schiumerini R
• Baccarini P
• Fornelli A
• Allegri D
• Lodato F
• Gazzola A
• Apolito P
• Longo NP
• Polifemo AM
• Patrizi F
• Buonfiglioli F
• Ghersi S
• Bassi M
• Ceroni L
• Ghetti A
• Fonti G
• Cennamo V

• KMID: 2566150
• DOI: http://doi.org/10.5946/ce.2024.113

Abstract

Background/Aims
Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).
Methods
This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.
Results
In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).
Conclusions
PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was “time-consuming”.

Keyword

Endoscopic and histological radicality; Polypectomy; Polyp retrieval failure; Post-polypectomy adverse events