ArticleGut2021
Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods.
Article in Gut, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it, 134 citations in OpenAlex.
- Cold EMR vs. Hot EMR for the removal of sessile serrated polyps larger than 10 mm: a systematic review and meta-analysis.BMC surgery · 2024Pooled it
- Cold versus hot polypectomy/endoscopic mucosal resection-A review of current evidence.United European gastroenterology journal · 2021Pooled it
- Trial
- Surveillance Outcomes in an Australian Cohort Undergoing Piecemeal Polypectomy for Conventional Adenomas and Serrated Lesions.Digestive diseases and sciences · 2026Observational
- Management of Colorectal Sessile Serrated Lesions in Elderly Patients.Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2026Review
- Endoscopic Assessment and Management of Colorectal Serrated Lesions: Current Comparative Practice, Challenges, and Future Directions.Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2026Review
- Gastrointestinal Tract Polyp Detection, Tracking, and Surveillance and the Role of Artificial Intelligence.Cureus · 2026Review
- Cold Snare Polypectomy and Cold Endoscopic Mucosal Resection Versus Hot Endoscopic Mucosal Resection for Intermediate-Size Sessile Serrated Lesions: A Randomized Controlled Trial.United European gastroenterology journal · 2026Article
- Histopathologic outcomes comparison between cold snare polypectomy and cold snare EMR for colorectal polyps: a full-thickness serial sectioning analysis.Gastroenterology report · 2026Article
- Constructing and validating a risk prediction model for postoperative bleeding after colorectal EMR in the Chinese population: a machine learning-based study.Surgical endoscopy · 2026Article
- Predictive Accuracy of Optical Evaluation for High-Risk Serrated Lesions and the Impact of a Brief Educational Intervention.Endoscopy international open · 2026Article
- The efficacy and safety of cold snare polypectomy in intermediate nonpedunculated polyps.BMC gastroenterology · 2025Article
- Sessile serrated lesions involving the appendiceal orifice: Endoscopic diagnosis and treatment.World journal of gastrointestinal endoscopy · 2025Review
- Updates in the endoscopic management of colorectal polyps.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2025Review
- Article
- Endoscopic approach to large non-pedunculated colorectal polyps.Journal of the Canadian Association of Gastroenterology · 2025Article
- Comparison of three electrosurgical modes for endoscopic mucosal resection of 10- to 20-mm colorectal polyps: Randomized controlled trial.Endoscopy international open · 2025Article
- Optimizing duodenal tissue acquisition for mechanistic studies of duodenal ablation in type 2 diabetes.Endoscopy international open · 2025Article
- Dual Channel Endoscopic Mucosal Resection.Clinics in colon and rectal surgery · 2024Review
- Endoscopic Resection of Neoplasia in the Lower GI Tract: A Clinical Algorithm.Visceral medicine · 2024Review
Corrections and comments
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Authors and funding
16 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveLarge (≥20 mm) sessile serrated lesions (L-SSL) are premalignant lesions that require endoscopic removal. Endoscopic mucosal resection (EMR) is the existing standard of care but carries some risk of adverse events including clinically significant post-EMR bleeding and deep mural injury (DMI). The respective risk-effectiveness ratio of piecemeal cold snare polypectomy (p-CSP) in L-SSL management is not fully known.
designConsecutive patients referred for L-SSL management were treated by p-CSP from April 2016 to January 2020 or by conventional EMR in the preceding period between July 2008 and March 2016 at four Australian tertiary centres. Surveillance colonoscopies were conducted at 6 months (SC1) and 18 months (SC2). Outcomes on technical success, adverse events and recurrence were documented prospectively and then compared retrospectively between the subsequent time periods.
resultsA total of 562 L-SSL in 474 patients were evaluated of which 156 L-SSL in 121 patients were treated by p-CSP and 406 L-SSL in 353 patients by EMR. Technical success was equal in both periods (100.0% (n=156) vs 99.0% (n=402)). No adverse events occurred in p-CSP, whereas delayed bleeding and DMI were encountered in 5.1% (n=18) and 3.4% (n=12) of L-SSL treated by EMR, respectively. Recurrence rates following p-CSP were similar to EMR at 4.3% (n=4) versus 4.6% (n=14) and 2.0% (n=1) versus 1.2% (n=3) for surveillance colonoscopy (SC)1 and SC2, respectively.
conclusionsIn a historical comparison on the endoscopic management of L-SSL, p-CSP is technically equally efficacious to EMR but virtually eliminates the risk of delayed bleeding and perforation. p-CSP should therefore be considered as the new standard of care for L-SSL treatment.
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