Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis

Background and study aims: Familial adenomatous polyposis (FAP) is generally managed by colectomy, but in some cases surgery is delayed and polyp burdens are managed endoscopically. We aimed to describe the use of cold snare polypectomy to control the polyp burden in selected patients with FAP. Patients and methods: This was a retrospective cohort study. Polyps were counted and the range of polyp size recorded at each examination. Patients with a reduction in polyp number and mean size were considered to have successful endoscopic reduction of their polyp burdens. Results: Of 79 patients with FAP, 21 had an attempt at delaying surgery by cold snaring of at least 30 adenomas, and had at least one follow-up at our institution. Ten patients had intact colons, 6 had intact rectums, and 5 had heavy polyp burdens in an ileo-anal pouch. Among the 21 patients, the mean number of polyps resected at the first examination was 85, range 30 – 342. Nineteen of 21 patients had fewer polyps at the second examination, and of those, only one had any persistence of adenomas ≥ 1 cm in size. During follow-up, two patients underwent surgical resection and the remainder had reductions in their polyp burdens at follow-up endoscopy. Conclusions: Cold snare polypectomy effectively reduces polyp burden in selected FAP patients.