| [ Summary ] |
Cold snare polypectomy (CSP) has been disseminated from western to eastern countries in the 21st century. It is now favored in lieu of conventional polypectomy with electrocauterization, so‒called "hot snare polypectomy (HSP)". CSP has less delayed bleeding and shorter procedure time than HSP. CSP without electrocautery decreases expansion of ulceration and damage of submucosal arteries after polypectomy compared with HSP. Low R0 resection rates are a recent concern regarding CSP, and extended CSP defined as CSP with a>1 mm circumferential margin can increase the negative lateral margin without elevating the rate of delayed bleeding. Recently, the indication of CSP is expanding to 6‒10 mm colorectal polyps. However, we must be cautious about the curability using CSP as it can only make a shallow resection. Therefore, careful observation of colorectal polyps with magnifying endoscopy using color enhancement is necessary before CSP to assess mucosal irregularity regardless of the size of colorectal polyp. When endoscopist feels a little concern about malignancy, switching from CSP to HSP with submucosal injection should be immediately performed for precise evaluation of vertical margin. |