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Cold Snare Polypectomy Without Submucosal Injection May Be the Treatment of Choice for Sessile Serrated Lesions 10 mm or Larger

Douglas K. Rex, MD, MASGE, reviewing Barros RA, et al. Endosc Int Open 2021 Sep.

In a multicenter, multinational study, retrospectively obtained data for 379 patients showed 615 sessile serrated lesions ≥10 mm in size resected by cold snare polypectomy without submucosal injection. The mean polyp size was 13.7 mm, with 19.8% of resected lesions ≥20 mm and 2.9% ≥30 mm.

There were no significant adverse events. At follow-up of 23.4 (SD, 11.6) months, the rate of residual/recurrent lesions was 7.8%.

Douglas K. Rex, MD, FASGE


The recurrence rate of 7.8% in this study is almost identical to the recurrence rate in the largest series with cold EMR for serrated lesions in the same size range. Given that resection without injection is faster and less expensive, these data suggest it is potentially superior to cold EMR, indicating the appropriateness of randomized controlled trials.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Barros RA, Monteverde MJ, Dumonceau JM, et al. Cold snare polypectomy without submucosal injection: safety and efficacy in 615 large serrated lesions. Endosc Int Open 2021;09:E1421-E1426. (

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