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Endoscopic mucosal resection (EMR) is standard therapy for nonpedunculated colorectal polyps ≥20 mm. It has been suggested recently that polyp resection without current (cold resection) may be superior to the standard technique using cutting/coagulation current (hot resection) by reducing adverse events (AEs), but evidence from a randomized trial is missing. In this randomized controlled multicentric trial involving 19 centers, nonpedunculated colorectal polyps ≥20 mm were randomly assigned to cold or hot EMR. The primary outcome was major AE (eg, perforation or postendoscopic bleeding). Among secondary outcomes, major AE subcategories, postpolypectomy syndrome, and residual adenoma were most relevant. Between 2021 and 2023, there were 396 polyps in 363 patients (48.2% were female) enrolled for the intention-to-treat analysis. Major AEs occurred in 1.0% of the cold group and in 7.9% of the hot group (P =.001; odds ratio [OR], 0.12; 95% CI, 0.03–0.54). Rates for perforation and postendoscopic bleeding were significantly lower in the cold group, with 0% vs 3.9% (P =.007) and 1.0% vs 4.4% (P =.040). Postpolypectomy syndrome occurred with similar frequency (3.1% vs 4.4%; P =.490). After cold resection, residual adenoma was found more frequently, with 23.7% vs 13.8% (P =.020; OR, 1.94; 95% CI, 1.12–3.38). In multivariable analysis, lesion diameter of ≥4 cm was an independent predictor both for major AEs (OR, 3.37) and residual adenoma (OR, 2.47) and high-grade dysplasia/cancer for residual adenoma (OR, 2.92). Cold resection of large, nonpedunculated colorectal polyps appears to be considerably safer than hot EMR; however, at the cost of a higher residual adenoma rate. Further studies have to confirm to what extent polyp size and histology can determine an individualized approach. German Clinical Trials Registry (Deutsches Register Klinischer Studien), Number DRKS00025170. [Display omitted] Cold resection of large nonpedunculated colorectal polyps appears to be safer than the hot technique with almost complete elimination of major AE, however, at the cost of a higher rate of residual neoplasia. [ABSTRACT FROM AUTHOR]

Abstract Background and aims Hot snare (HS) is widely used for the resection of adenomas >5 mm. The cold snare (CS) has a better safety profile and is more cost-effective. The aims of this study were to evaluate effectiveness and safety of CS polypectomy (CSP) compared to HS polypectomy (HSP) for adenomas sized 5–10 mm and 11–20 mm. Methods 4018 colonoscopies performed within "quality certificate for screening colonoscopy" with one polypectomy of an adenoma sized 5–20 mm each were included. Retrieval rates, complete resection rates and complication rates were assessed and compared between CSP and HSP for adenomas sized 5–10 mm and 11–20 mm. Histologic subgroups were additionally assessed. Results Complete resection rates (5–10 mm: CSP: 89.4% vs. HSP: 87.9%, p = 0.33; 11–20 mm: CSP: 81.8% vs. 80.9%; p = 1), retrieval rates (5–10 mm: CSP: 99.5% vs. HSP: 99.4%, p = 0.76; 11–20 mm: CSP: 100% vs. HSP: 99%, p = 1) and complication rates (5–10 mm: CSP: 0.2% vs. HSP: 0.2%; p = 1; 11–20 mm: CSP: 0% vs. HSP: 1%, p = 1) were equal between CSP and HSP for adenomas sized 5–10 mm as well as 11–20 mm. For serrated adenomas sized 5–10 mm, HSP was superior to CSP (88.7% vs. 77.2%, p < 0.05) regarding the complete resection rate, but not for advanced adenomas (HSP: 89.1% vs. 87.3%, p = 0.69) or adenomas with high-grade dysplasia (HSP: 76.7% vs. 75%, p = 1). Conclusion This study further supports the use of CSP for polyps sized 5–10 mm and additionally suggests also using CSP for polyps sized 11–20 mm. These findings, as well as the best method for resection of serrated polyps should be validated in further studies. [ABSTRACT FROM AUTHOR]