# A36 SERRATED POLYPOSIS SYNDROME OUTCOMES IN THE COLD SNARE RESECTION ERA

## TL;DR

This study evaluates the effectiveness of cold snare resection as a primary treatment for serrated polyposis syndrome, showing improved outcomes compared to previous methods.

## Contribution

The study introduces and evaluates a primary cold snare resection algorithm for managing serrated polyposis syndrome.

## Key findings

- Endoscopic clearance was achieved in 88.2% of patients using cold snare resection.
- Only 2.9% of patients required surgery in the post-PCSRA group.
- Cold snare resection was associated with fewer adverse events compared to prior methods.

## Abstract

Surgery is indicated in patients with serrated polyposis syndrome [SPS] when the polyp burden is no longer manageable endoscopically. Evidence has emerged supporting the efficacy and safety of cold snare resection [CSR] for large sessile serrated lesions; however, the role of a primary cold snare resection algorithm [PCSRA] in patients with SPS is unknown

We aimed to evaluate the efficacy of a PCSRA in patients with SPS

Utilizing an established retrospective cohort (2013-2023), all patients with a diagnosis of SPS were evaluated, based on the 2019 World Health Organization [WHO] criteria. Patients were stratified by index colonoscopy into the pre-PCSRA (01/2013-12/2020) and the post-PCSRA (01/2021-08/2023). Outcomes included achieving clearance (complete removal of all serrated class lesions [SCL] at procedure completion), adverse events, and referral for surgery. Continuous and categorical variables were summarised using median (IQR) and frequencies respectively. Fisher Exact test was used to compare categorical variables.

178 patients with SPS were included in the analysis (N=144, 80.9% pre-PCSRA; N=34, 19.1% post-PCSRA). Median age at first colonoscopy was 62 years (IQR 9 years) and 115 (64.6%) were female. In the post-PCSRA, 593 SCLs were identified: 326 diminutive (< 5mm), 147 small (5-9mm), 66 medium (10-19mm), and 54 large (≥ 20mm). Among both SCLs and adenomatous lesions, 93.4% (N=627) were removed by CSR. Endoscopic clearance was achieved in 30 (88.2%) patients and 1 patient (2.9%) underwent surgery, which preceded referral for endoscopic management. In comparing the pre-PCSRA vs. the post-PCSRA: 110 (76.4%) achieved clearance in the pre-PCSRA group (P=0.09). No delayed bleeding was observed in the post-PCSRA group as opposed to 3 (2.2%) in pre-UCSRA (p = 0.50). Intra-procedural perforation was reported in 1 patient in the post-PCSRA vs. 2 in the pre-PCSRA group (p=0.47). Only 1 delayed perforation was reported in the pre-PCSRA group (p=0.81). Twenty-one (13.9%) patients underwent surgery: 20 in the pre-PCSRA (94.7%; 9 due to polyp burden and 11 for colorectal cancer) and 1 in the post-PCSRA (colorectal cancer) (p=0.08).

Cold snare resection should be considered as the first-line resection modality for most lesions identified in patients with SPS.

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