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Background Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5–9 mm polyps in terms of complete resection and adverse events. Methods This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 1 5–9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without 9 mm polyps. Results 496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval –1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) (P = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %; P = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %; P = 0.01). Conclusions We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.

Introduccion: Las tecnicas convencionales para el diagnostico cito-histologico de las lesiones subepiteliales gastrointestinales (LSEGI) presentan limitaciones. La PAAF por ecoendoscopia aporta escaso material, especialmente en lesiones pequenas o de origen mesenquimal que precisan analisis inmunohistoquimico (IH). La incision con esfinterotomo de aguja y biopsia con pinza (IEA-BP) guiada por ecoendoscopia, es una tecnica de reciente desarrollo, con resultados iniciales prometedores Objetivo: Analizar las caracteristicas de las LSEGI del tracto digestivo superior valorando rendimiento diagnostico y seguridad de la IEA-BP en su estudio cito-histologico. Material y Metodo: Entre abril 2010- junio 2013 se recogieron prospectivamente todas las LSEGI. Se valoro morfologia y vascularizacion con ecoendoscopio sectorial/doppler, realizandose una incision superficial de 6 mm, con EA y potencias 30 – 60 W, introduciendose pinza convencional de biopsia, extrayendose 3 – 5 muestras para formol. En las lesiones mesenquimales se realizo IH y determinacion de indice mitotico (IM). En 8 pacientes se realizo simultaneamente PAAF-22G. Se definieron como lesiones “pequenas”: O < 20 mm. Resultados: Se incluyeron 61 pacientes (V/M: 30/31). Edad media 60.05 anos (22 – 89). Diametro medio: 2.31 cm (0.65 – 9.31). Localizacion: Esofago/estomago/duodeno: 4/51/6. Capa: 2a/3a/4a: 5/29/27. Etiologia: GIST: 21, pancreas ectopico: 11, lipoma: 7, leiomioma: 3, polipo fibroide: 6, otras: 5, no diagnostica: 8. Rendimiento global: 53/61: 86.88%. Lesiones pequenas/grandes: 30/31: rendimiento pequenas: 25/30 (83.33%): rendimiento grandes: 28/31: 90.32% (p < 0.02). La PAAF solo resulto diagnostica en 1/8 casos (12.5%).. El analisis IH (CD 117/CD 34) fue factible en 20/21 GIST (95.23%) y para IM en 16/21 (76.19%). No existieron complicaciones. Conclusiones: La IEA-BP asistida por ecoendoscopia es una tecnica segura y de alto rendimiento en el estudio de las LSEGI incluso en aquellas de menor tamano, constituyendo una alternativa eficaz a la PAAF