Experienced colonoscopists know that when a small polyp is encountered during insertion, it is best to remove it immediately, as identifying it during withdrawal is sometimes difficult.
In a randomized controlled trial involving 1451 patients, 220 patients were eligible for randomization to either removal of a left-sided lesion <1 cm in size during insertion or saving it for removal during withdrawal. The mean actual time for intubating the cecum was similar between the two groups, but total procedural time was substantially shorter in the group with polyps removed during insertion (18.9 vs 22.3 minutes; P <0.001). In the group randomized to polyp removal during withdrawal, 44.8% required repeated examinations of the left colon to locate the polyp, and 6.5% of polyps were never found. The group that required multiple examinations and the group with entirely lost polyps resulted in reinspection times of 2.5 and 4.7 minutes, respectively.
Teramoto A, Aoyama N, Ebisutani C, et al. Clinical importance of cold polypectomy during the insertion phase in the left side of the colon and rectum: a multicenter randomized controlled trial (PRESECT STUDY). Gastrointest Endosc
2019 Dec 23. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2019.12.019