The Resection Ability of Low-power Pure-cut Hot Snare Polypectomy for Nonpedunculated Colorectal Polyps Smaller Than 10 mm: A Single-center Prospective Study.

Objectives: Small colorectal polyps sometimes include high-grade adenomas or carcinomas that require endoscopic resection with electrocautery. Recent studies have reported the usefulness of low-power pure-cut hot snare polypectomy (LPPC-HSP) as a less invasive technique. However, the actual resection depth of LPPC-HSP has not been fully investigated. Therefore, this study aimed to evaluate the resection ability of LPPC-HSP for small colorectal polyps. Methods: In this single-arm prospective observational study, patients scheduled to undergo LPPC-HSP for nonpedunculated colorectal polyps smaller than 10 mm were enrolled. The primary outcome was the rate of sufficient vertical R0 resection (SVR0), defined as an R0 resection with a sufficient submucosal layer beneath the whole lesion. Results: A total of 95 patients with 150 lesions were included. The en bloc and R0 resection rates were 100% and 83%, respectively. The SVR0 rate was 76.7% (90% confidence interval: 70.3%-82.2%). All specimens contained the muscularis mucosa, and 132 lesions (88%) contained submucosal tissue. The median maximum submucosal thickness was 1331 µm (interquartile range, 736-2044 µm). No bleeding, perforation, or other serious adverse events were observed. Conclusions: LPPC-HSP demonstrated acceptable vertical resection capability. LPPC-HSP may be applicable for colorectal polyps smaller than 10 mm with potential malignancy, providing resection depth comparable to that of conventional electrocautery-based methods.