Evaluation of Cold Forcep and Cold Snare Polypectomy for Polyps Less Than or Equal to 3mm in Size During Colonoscopy

Evaluation of Cold Forcep and Cold Snare Polypectomy for Polyps Less Than or Equal to 3mm in Size During Colonoscopy

Randomized Controlled Trial Investigating Cold Snare aNd Forcep polypectomY Among Small POLYPs in Rates of Complete Resection: the TINYPOLYP Trial.

The focus of the study is to evaluate impact of cold forcep and cold snare in achieving complete resection during polypectomy of polyps <=3mm during colonoscopy.

The details of the proposed study are as follows: Experimental group: using cold forceps for polyps <=3mm of the colon Control group: using cold snare for polyps <=3mm of the colon Methods: Colonoscopy will be performed in the same standard of care manner as if no study was taking place. If polyps <=3mm are identified, the endoscopist is randomized to performing polypectomy with cold forcep or cold snare. After removal of the polypectomy, two biopsies are performed at the margin of the polypectomy site to identify residual lesion. The polyp as well as well as the two biopsies are reviewed by a pathologist.

Removal of appropriate polyps using cold forceps until no polyp visible under white light. Two additional biopsies performed at margins of polypectomy site.

Removal of appropriate polyps using cold snare until no polyp visible under white light. Two additional biopsies performed at margins of polypectomy site.

The primary outcome measured is comparison of completeness of resection between the cold forcep and cold snare groups.

The time between the forceps or snare is introduced till the polyp is removed and retrieved will be compared.

We will compare the number of bites or snare attempts needed to remove the tissue adequately to the endoscopist's judgment.

We will compare rates of complications including perforation and immediate post-polypectomy bleeding, early post-polypectomy bleed (within 24 hours) and delayed post polypectomy bleed (between 24 hours and 30 days). Early post-polypectomy bleed and delayed post-polypectomy bleed is evaluated based on emergency room (ER) visit, inpatient stay, transfusion needed, repeat colonoscopy required, surgical intervention required, and mortality.

Inclusion Criteria: Patients 18 years or older Polyps <=3mm Exclusion Criteria: Pregnant Inflammatory bowel disease Polyposis syndromes

Wei MT, Louie CY, Chen Y, Pan JY, Quan SY, Wong R, Brown R, Clark M, Jensen K, Lau H, Friedland S. Randomized Controlled Trial Investigating Cold Snare and Forceps Polypectomy Among Small POLYPs in Rates of Complete Resection: The TINYPOLYP Trial. Am J Gastroenterol. 2022 Aug 1;117(8):1305-1310. doi: 10.14309/ajg.0000000000001799. Epub 2022 Apr 25.