When Cold Snare Is Not Enough for a 6 to 10 mm Colon Polyp

A 6 to 10 mm colon polyp can look routine until the shape, margin, and histology make the resection less forgiving. In this clip, Klaus reviews why a small lesion still needs an individualized plan. The goal is simple: remove the lesion safely, completely, and with margins that can stand up to pathology.

Why Shape Should Drive the Resection

The key teaching point is that the polyp tells you how it wants to be resected. Cold snare can be ideal for a small sessile or slightly elevated lesion, but lateral margins may not always be included. Serrated and flatter lesions are the ones that deserve extra attention.

Klaus points to evidence showing incomplete resection in up to one third of serrated lesions after plain polypectomy. That is why a more deliberate approach matters. Sometimes that means choosing a dedicated cold snare with a stiff wire and shaft. Sometimes it means suctioning or injecting the lesion to reshape it before placing the snare.

The Practical Decision

• Shape first. Small sessile or slightly elevated lesions are the best cold-snare candidates.
• Choose the snare. Dedicated cold snares with adequate shaft strength give better control than a soft, oversized loop.
• Reshape before you cut. Suction or inject flat or subtle lesions so the snare can take normal tissue with the margin.

Klaus shows the exact moment when suction or injection changes the resection plan.

Watch how he selects the snare, reshapes the lesion, and checks whether the margins are likely to be complete.