Are all cold snares the same in the era of cold revolution?

Abstract

Introduction: The European Society of Gastrointestinal Endoscopy presently recommends cold snare polypectomy (CSP) as the preferred modality in resecting diminutive polyps (size ≤ 5mm) and small polyps (6-9 mm), given its superior safety profile. Dedicated cold snares achieve these means of optimal CSP through their stiffer and thinner wire (0.30 mm) designs compared to traditional ones (0.47 mm), thus enabling cleaner cuts compared to tissue shearing resulting from thick wire snares. Despite the various cold snares available in the market, there are no direct comparison studies.

Methods: We retrospectively analysed prospectively collected data on all resected polyps measuring  9 mm in our repository from February 2020 to June 2022. The cold snares used throughout the study duration were the Olympus SnareMaster Plus (10 mm) (hexagonal), STERIS Exacto Cold Snare (shield), and Boston Captivator Cold Single-use Snare (oval).

Results: 714 diminutive and small colorectal polyps were cold resected with the Olympus SnareMaster Plus (n=236; diminutive n=174 and small n=62), STERIS Exacto (n=174; diminutive n= 114 and small n=60) and Boston Captivator Cold (n=304; diminutive n=248 and small n=56). There were seven episodes of prolonged post-polypectomy bleeding (lasting > 30 seconds) requiring endotherapy, for which 6 were a result of STERIS Exacto snares, whereas one was from the Boston Captivator. Our dataset revealed a bleeding complication rate of 0.009% with successful endoscopic therapy, while there were no cases of delayed bleeding, perforation, incomplete resection, and conversion to hot snaring.

Discussion: Barring the unfortunate post-polypectomy bleeding, given individual patient circumstances and polyp characteristics, the three leading snares in the polypectomy market seem to share equal successes. Based on these observations, personal preference and device familiarity may play a role in snare selection as the effectiveness and low adverse events do not justify a distinction between them.

Full text

Are all cold snares the same in the era of cold
revolution?
Authors: Daniel Ching1, Keng Hoong Chiam1,
Raman Muthukaruppan1
Institution: Queen Elizabeth Hospital, Kota Kinabalu
Sabah
Poster
No.49 Institutional
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Introduction: The European Society of Gastrointestinal Endoscopy presently
recommends cold snare polypectomy (CSP) as the preferred modality in resecting
diminutive polyps (size ≤ 5mm) and small polyps (6-9 mm), given its superior safety
profile. Dedicated cold snares achieve these means of optimal CSP through their stiffer
and thinner wire (0.30 mm) designs compared to traditional ones (0.47 mm), thus
enabling cleaner cuts compared to tissue shearing resulting from thick wire snares.
Despite the various cold snares available in the market, there are no direct comparison
studies.
Methods: We retrospectively analysed prospectively collected data on all resected
polyps measuring 9 mm in our repository from February 2020 to June 2022. The cold
snares used throughout the study duration were the Olympus SnareMaster Plus (10
mm) (hexagonal), STERIS Exacto Cold Snare (shield), and Boston Captivator Cold
Single-use Snare (oval).
Results: 714 diminutive and small colorectal polyps were cold resected with the
Olympus SnareMaster Plus (n=236; diminutive n=174 and small n=62), STERIS Exacto
(n=174; diminutive n= 114 and small n=60) and Boston Captivator Cold (n=304;
diminutive n=248 and small n=56). There were seven episodes of prolonged post-
polypectomy bleeding (lasting > 30 seconds) requiring endotherapy, for which 6 were a
result of STERIS Exacto snares, whereas one was from the Boston Captivator. Our
dataset revealed a bleeding complication rate of 0.009% with successful endoscopic
therapy, while there were no cases of delayed bleeding, perforation, incomplete
resection, and conversion to hot snaring.
Discussion: Barring the unfortunate post-polypectomy bleeding, given individual
patient circumstances and polyp characteristics, the three leading snares in the
polypectomy market seem to share equal successes. Based on these observations,
personal preference and device familiarity may play a role in snare selection as the
effectiveness and low adverse events do not justify a distinction between them.
Exacto (US Endoscopy) Olympus SnareMasterPlus Boston Captivator Cold Snare