Efficacy of hot biopsy forceps, cold micro-snare and micro-snare with cautery techniques in the removal of diminutive colonic polyps

It is not possible with standard colonoscopy to determine whether dimunitive polyps (5mm or less) are hyperplastic or adenomatous and therefore most physicians remove all visualized polyps. Several techniques can be used to remove diminutive polyps including hot biopsy which results in incomplete polyp eradication 15-25% of the time. In this study patients were randomized to one of three polypectomy techniques; hot biopsy, cold microsnare or microsnare with cautery to determine if efficacy rates differed between the three methods. Methods: Patients undergoing nonemergent colonoscopy without coagulation abnormalities were recruited for the study. Patients with ≤ 3 polyps which were less than 6mm in size were eligible for the study if the polyps were located within the distal 20cm. Each specimen was placed in separate formalin containers for pathologic examination. Seven to ten days later the patient returned for a flexible sigmoidoscopic examination of the polyp site(s). Biopsies were taken of the sites and examined histologically for residual polyp (adenomatous or hyperplastic). Efficacy was based on whether microscopic evidence of residual polyp was found. RESULTS Microsnare Cold Hot Biopsy with cautery Microsnare # of polyps '20 29 23 Residual polyps 1(5%)* 4(14%) 5(22%)* * p=0.098 Chi square analysis was performed between each of the three techniques and no statistically significant difference was achieved. Conclusion: There was a trend towards better efficacy with microsnare cautery when compared with hot biopsy However, it was not statistically significant which may be due to the small sample size.