Cold Snare Polypectomy - Tips and Tricks - Before initiating cold snare polypectomy, it is important to define the borders and size of the polyp. - This is most important when a polyp is extending proximal to a fold and in the management of serrated lesions, wherein the borders may be challenging to delineate. - Once the polyp borders are defined, it is essential to try to place the polyp in an ideal position for resection. In most cases, this requires placement of the polyp at the 5 to 7 0' clock positions to match the accessory channel of the colonoscope and maintaining a short distance to the polyp. - The snare tip can be anchored to the normal mucosa at the proximal edge of the polyp, and the snare is then slowly opened so that the remainder of the polyp is within the snare. This is useful to ensure that the proximal edge of the polyp is not missed during snare closure. - Alternatively, the snare can be fully opened 'above' the polyp and then laid down flat against the mucosa. It is very important to lay the snare down parallel to the mucosa, flush against the wall. At this point, air can be suctioned to ease capture of the polyp, and the snare is slowly closed to grasp and then resect the lesion. - After resection of the lesion, it is important to examine the polypectomy defect to ensure that the entire lesion has been resected. By Dr. Steven Bollipo @stevenbollipo and Dr. Enrik Aguila @enrrikke #ColdSnare #Polypectomy #Tips #Tricks#management #gastroenterology #fellows #colonoscopy
