Cold Snare Versus Double Biopsy Polypectomy Technique for Removal of Diminutive Colorectal Polyps

• Time taken for polypectomy (complete visual eradication of each polyp) [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
  time from polyp resection to tissue retrieval
• Successful tissue retrieval rate of removed tissues [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
• Rates of adverse events [ Time Frame: 4 weeks ] [ Designated as safety issue: Yes ]
  Adverse events include postpolypectomy bleeding and others (polypectomy syndrome or perforation).
• Complete visual polyp eradication rate [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]

• Time for complete visual eradication of each polyp [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
  time from polyp resection to tissue retrieval
• Successful tissue retrieval rate of removed tissues [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
• Rates of adverse events [ Time Frame: 4 weeks ] [ Designated as safety issue: Yes ]
  Adverse events include postpolypectomy bleeding and others (polypectomy syndrome or perforation).
• Complete histological polyp eradication rate [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]

Most of colorectal polyps founded during colonoscopy are diminutive polyps less than 6 mm. However, complete removal of diminutive polyps is required to prevent tumor recurrence and development of potential interval cancers. Currently, a variety of polypectomy techniques such as hot snare, cold snare, and cold forceps polypectomy are frequently used for the removal of diminutive colorectal polyps. In regard to the completeness of polypectomy, there are few data comparing cold snare polypectomy with cold forceps biopsy technique for removal of diminutive (1-5 mm) colorectal polyps. The aim of this study is to compare cold snare polypectomy with cold forceps polypectomy using double biopsy technique for removal of diminutive colorectal polyps.

• Procedure: removal of eligible polyps using cold snare polypectomy technique
  Snare polypectomy using a mini (10 mm open diameter) size electrosurgical snare without application of electrocautery
• Procedure: removal of eligible polyps using double biopsy technique
  Cold forceps polypectomy using a standard- capacity forceps with double biopsy technique (two bites per one forceps pass)

• Experimental: Cold snare polypectomy
  Intervention: Procedure: removal of eligible polyps using cold snare polypectomy technique
• Experimental: Double biopsy polypectomy
  Intervention: Procedure: removal of eligible polyps using double biopsy technique

• Church JM. Clinical significance of small colorectal polyps. Dis Colon Rectum. 2004 Apr;47(4):481-5. Epub 2004 Mar 4.
• Draganov PV, Chang MN, Alkhasawneh A, Dixon LR, Lieb J, Moshiree B, Polyak S, Sultan S, Collins D, Suman A, Valentine JF, Wagh MS, Habashi SL, Forsmark CE. Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps. Gastrointest Endosc. 2012 Jan;75(1):118-26.
• Efthymiou M, Taylor AC, Desmond PV, Allen PB, Chen RY. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy. 2011 Apr;43(4):312-6. Epub 2011 Mar 16.

Inclusion Criteria:

• Patients over the age of 20
• Informed consent

Exclusion Criteria:

• Patient undergoing antiplatelets (aspirin, clopidogrel and others) or anticoagulant therapy
• Known existing bleeding tendency (thrombocytopenia or prolonged INR)
• Inflammatory bowel diseases (Crohn's disease, or ulcerative colitis)
• ASA class III or more
• Pregnancy
• Any condition which, in the opinion of the Investigator, places the patient at unacceptable risk if he/she were to participate in the study