Cold Snare Polypectomy in Pediatric Polyposis: A Multicenter Experience

Abstract

Background: Cold snare polypectomy (CSP) is a well-established and recommended technique in adult gastroenterology for the safe, efficient and complete removal of nonpedunculated lesions up to 10 mm, with piecemeal excision possible for larger lesions. However, the application of CSP in pediatric patients remains underexplored. This study summarizes a multicenter experience of CSP in pediatric polyposis patients, focusing on safety, efficacy and clinical outcomes. Methods: This retrospective study was conducted at two pediatric tertiary centers, encompassing patients aged 1 to 21 years with polyposis who underwent colonoscopy with CSP and hot snare polypectomy (HSP) between January 2022 and January 2023. Patient demographics, procedure characteristics, polyp details and clinical outcomes were analyzed. Results: A total of 477 CSPs were performed in 63 colonoscopies. Satisfactory bowel preparation was noted in 79% of procedures, with a pooled mean procedure duration of 52 min and cecal intubation achieved in 98%. Polyps resected by CSP ranged from 3 to 70 mm in size and were predominantly left-sided. Tissue retrieval was complete in 94% of cases and partial in 5%. Mild intraprocedural bleeding occurred in 25% of CSP cases, requiring endoclip placement in 19%, with no post-procedural bleeding or significant complications observed. Comparatively, CSP demonstrated favorable bleeding rates relative to HSP. At two-week follow-up, four patients required emergency evaluation for unrelated complaints, but with no adverse events attributed to CSP. Conclusions: CSP is a safe and effective technique for the removal of sessile polyps in pediatric patients with polyposis. Mild intraprocedural bleeding, when observed, was effectively managed with standard hemostatic techniques. These findings support the potential of CSP as a preferred modality for sessile polyp removal in pediatric patients, though further research is warranted to define its role across broader pediatric populations and practice settings.