Table 2.

Technical Tips for the Removal of SSA/Ps (<10 mm) by Cold Snare Polypectomy

Position the lesion in the 5 to 6 o’clock position. Place the catheter of the opened snare on normal mucosa 1 to 2 mm distal to the lesion with the snare tip 1 to 2 mm proximal to the lesion. Stiff thin-wire snares are likely more effective. Anchor the catheter in place on the mucosa by downward angulation of the scope tip (pushing forward on the up/down wheel). Close the snare, capturing the polyp with a margin of normal tissue. Avoid excessive distention of the colon as tension on the wall will cause the closing snare to slide over the mucosa, impeding tissue capture. If this occurs, gently deflating the lumen during snare closure may be helpful. Small flat nonpolypoid lesions (Paris 0-IIa and 0-IIb morphology) can be difficult to capture. A suction pseudopolyp technique, whereby the lesion is aspirated into the suction channel of the colonoscope and continuous suction applied for 5 seconds whilst the colonoscope is gently retracted, allows formation of a pseudopolyp to facilitate subsequent resection. This has been shown to be a safe, effective and reproducible therapy for removal of these lesions.111,112 Expand the mucosal defect following polypectomy by water jet irrigation. This distends the defect and its edges, facilitating inspection for residual polyp tissue.

SSA/Ps, sessile serrated adenoma/polyps.