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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]

In the management of small and diminutive polyps, cold polypectomy is favored over electrocautery polypectomy. However, the optimal cold polypectomy technique is still controversial. Hence, this review aims to investigate the most effective cold technique for small and diminutive colorectal polyps. We conducted a systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) which were retrieved by systematically searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane through 10 February 2023. R software, (R version 4.2.0) and meta-insight software were used to pool dichotomous outcomes using risk ratio (RR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022345619. Nineteen RCTs with 3649 patients and 4800 polyps were included in our analysis. Cold techniques (cold forceps polypectomy (CFP), jumbo forceps polypectomy (JFP), dedicated cold snare polypectomy (D-CSP), conventional cold snare polypectomy (C-CSP), underwater cold snare polypectomy (U-CSP), and cold snare endoscopic mucosal resection (CS-EMR) were included in our comparative analysis. CFP was less effective in achieving complete histological resection than C-CSP (RR: 1.10 with 95% CI [1.03–1.18]), CS-EMR (RR: 1.12 with 95% CI [1.02–1.23]), D-CSP (RR: 1.17 with 95% CI [1.04–1.32]), and U-CSP (RR: 1.21 with 95% CI [1.07–1.38]). However, the rest of the comparisons showed no difference. CFP is the least effective method for small and diminutive polyps' removal, and any snare polypectomy technique will achieve better results, warranting more large-scale RCTs to investigate the most effective snare polypectomy technique. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is internationally the third leading cause of death from a malignant disease. The aim of screening colonoscopy in adults > 45 years of age is early diagnosis and treatment of precancerous polyps. Endoscopic polyp removal (polypectomy) can be achieved with various techniques depending on the size, morphology, and location of the polyp. According to current guidelines, small non-pedunculated polyps should be removed with a cold snare after the colorectal lumen has been insufflated with air (conventional cold snare polypectomy).In recent years, several studies have described the benefits of water aided colonoscopy, as well as the safety and efficacy of underwater cold snare polypectomy for large colon polyps. However, there are insufficient data on conventional and underwater techniques for small polyps, the most commonly diagnosed colorectal polyps. Methods: We have designed a prospective randomized double-blind clinical trial to compare the safety and efficacy of conventional and underwater cold snare polypectomy for non-pedunculated polyps 5–10 mm in size. A total of 398 polyps will be randomized. Randomization will be carried out using the random numbers method of Microsoft Excel 2016. The primary endpoint is the muscularis mucosa resection rate. Secondary endpoints are the depth and percentage of R0 excisions, complications, and the recurrence rate at follow-up endoscopy 6–12 months after polypectomy. Discussion: We hypothesize underwater polypectomy will result in a higher muscularis mucosa resection rate. The results of our study will provide useful data for the development of guidelines in polypectomy techniques for non-pedunculated polyps 5–10 mm in size. Clinical trial registration: Clinicaltrials.gov, NCT05273697. [ABSTRACT FROM AUTHOR]

Purpose of review: Cold snare polypectomy (CSP) has been emerging as increasingly popular technique for the removal of colorectal polyps with expanding indications with regard to larger polyps. We reviewed the recent literature to provide an overview of the indications, outcomes, and recent developments in the field of CSP. Recent findings: There are currently 2 major guidelines recommending the use of CSP for 1–9 mm polyps, with one guideline suggesting its use for 10–19 mm polyps. There have been more than 30 published studies reporting on CSP outcomes in various patient populations, mostly in 1–9 mm polyps. Research suggests that CSP is safe and effective for the resections of 1–9 mm polyps, although its safety superiority over hot snare polypectomy (HSP) is not as clear except for patients on anticoagulation and antithrombotic medication. Data on CSP in 10–19 mm polyps is currently lacking; however, some research suggests higher incomplete resection compared to HSP. There is limited data suggesting that CSP could be non-inferior to HSP for 10–15 mm polyps and that hot endoscopic mucosal resection (EMR) could be superior to CSP for larger polyps with regard to recurrence risks. Cold EMR has been emerging as a potentially safe and effective tool for the resection of ≥ 20 mm sessile serrated lesions (SSLs); however, the potentially associated recurrence risk (especially for adenomas) requires further investigation in research studies. Summary: CSP can be used safely and effectively in 1–9 mm polyps. There is a lack of data on the efficacy and safety of CSP over HSP and conventional EMR for polyps 10–19 mm. Cold EMR seems to be effective and safe in the resection of ≥ 20 mm SSLs. More research is needed to expand the indications of CSP for its use in routine endoscopic removal of ≥ 10 mm polyps. [ABSTRACT FROM AUTHOR]

Background/Aims Large non-pedunculated colorectal polyps (>20 mm) can be effectively managed with hot snare EMR (H-EMR); however, electrocautery-related complications may incur substantial morbidity. It has been suggested that cold snare EMR (C-EMR) may be better than H-EMR because of fewer adverse events. This meta-analysis aims to compare the outcomes of H-EMR and C-EMR. Methods Relevant studies were identified through systematic searches of PubMed, MEDLINE, Cochrane, and Google Scholar databases. Out of 173, four eligible studies (2 randomized controlled trials and 2 retrospective studies) were included in the analysis. A quality assessment was performed using the Cochrane Risk of Bias tool for the RCTs and the Newcastle-Ottawa scale for the retrospective studies. Results A total of 1293 large non-pedunculated colorectal polyps resected using EMR were included (367 C-EMR vs. 906 H-EMR). There is no statistically significant difference in the technical success rate of C-EMR compared to H-EMR (OR 2.11, 95% CI [0.14-31]; I²=67%). Additionally, there is no significant difference in the risk of perforation between the two methods (OR 0.23, 95% CI [0.04-1.30]; I²=0%). H-EMR has a higher risk of delayed bleeding compared to C-EMR (OR 0.2, 95% CI [0.07-0.56]; I²=0%). In contrast, C-EMR has been shown to have a higher rate of polyp recurrence compared to H-EMR (OR 2.56, 95% CI [1.40-4.70]; I²=43%). Conclusion C-EMR is non-inferior to H-EMR in the resection of large nonpedunculated colonic polyp. C-EMR appears considerably safer with a lower risk of delayed bleeding than H-EMR; however, at the cost of a higher polyp recurrence rate. [ABSTRACT FROM AUTHOR]

Background and Aim Cold snare polypectomy is safe and efficacious for removing polyps

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Background and Aim: Cold snare polypectomy is safe and efficacious for removing polyps <10 mm with reduced rates of delayed postpolypectomy bleeding and postpolypectomy syndrome. This technique can also be used for sessile polyps ≥10 mm; however, further evidence is required to establish its safety. The aim of this study was to compare intraprocedure and postprocedure adverse events in patients who underwent cold (CSP) versus hot snare polypectomy (HSP) of 10–20 mm sessile colonic polyps. Methods: Electronic medical records and endoscopy reports of all patients who underwent polypectomy for Paris 0‐IIa, Is, or 0‐IIa + Is 10–20 mm colonic polyps between January 2015 and June 2017 at three tertiary academic hospitals and one private hospital were retrospectively reviewed. Data on patient demographics, polyp characteristics, method of polypectomy, and intraprocedural and postpolypectomy adverse events were collected. Results: A total of 408 patients (median age 67, 50% male) had 604 polyps, 10–20 mm in size, removed. Of these, 258 polyps were removed by HSP, with a median size of 15 mm (interquartile range [IQR] 12–20), compared to 346 polyps that were removed by CSP, with median size of 12 mm (IQR 10–15), P < 0.001. In the HSP group, 15 patients presented with postprocedure complications, including 11 with clinically significant bleeding, 2 with postpolypectomy syndrome, and 2 with abdominal pain. This compares with no postpolypectomy complications in the CSP group, P < 0.001. Conclusion: In this study, CSP was not associated with any postpolypectomy adverse events. CSP appears to be safer than HSP for removing 10–20 mm‐sized sessile polyps. A prospective multicenter study has been commenced to verify these findings and to assess the efficacy of CSP for the complete resection of polyps of this size. [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]

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Colon & Rectum is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Polypectomy has been shown to reduce the incidence of colorectal cancer. The ESGE guidelines from 2017 recommends that cold snare polypectomy should be used for removal of the diminutive polyps, smaller than 5 mm and also for sessile polyps 6 - 9 mm in size. This recommendation is based on lower complication rates and higher complete resections. Objectives. The goal of the study is to establish if the cold snare polypectomy is safe in removing the polyps smaller than 1 cm. Methods. The patients with polyps detected at colonoscopy between 2020-2022 years in the Gastroenterology Clinic from the Emergency Hospital, Targu-Mures entered this study. Results. From the total number of the polyps (753), 623 (82,73%) were adenoma and 130 (17,26%) were sessile. From the last group 83 were hyperplastic polyps, 35 sessile serrated lesions (SSL) and 12 traditional serrated adenomas (TSA). The hyperplastic polyps and 75% of the SSA were resected with cold snare, being less than 1cm. There were no bleedings and no complications. The rest of the SSL were resected by hot snare, with no complications either. Conclusions. Cold snare polypectomy is safe in serrated lesions less than 1 cm. There are recently published studies that demonstrated that cold snare polypectomy is safe also in SSA larger than 1 cm, however this has to be further established in the future guidelines. [ABSTRACT FROM AUTHOR]

Background and Aim Cold snare techniques are widely used for the removal of small and diminutive polyps. The influence of snare type on the effectiveness of cold snare polypectomy is unknown. Methods Cold snare polypectomy of 3-7-mm polyps was undertaken using either a thin wire mini-snare (0.30 mm) or a thick wire mini-snare (0.47 mm). Primary outcome was endoscopic completeness of excision. Consensus regarding endoscopic assessment of completeness of excision was standardized and aided by chromoendoscopy. Secondary outcomes included: completeness of histological excision, polyp 'fly away', polyp retrieval rate, early or delayed bleeding and perforation. Results One hundred and fifty-seven polyps were removed ranging from 3 to 7 mm, 62% were situated in the left side of the colon and 89.4% were sessile. Endoscopic completeness of excision was significantly higher with the thin wire snare compared to the thick wire snare (90.2% vs 73.3%, P < 0.05). There was a numerical trend towards a higher complete histological excision rate with the thin wire snare, but this did not reach statistical significance (73.3% vs 65.2%, P = 0.4). There was a fair level of agreement (kappa = 0.36) between endoscopic and histological completeness of excision. Polyp 'fly away' occurred less often with the thin wire snare (14.6% vs 35.3%, P = 0.002), but there was no significant difference in polyp retrieval rate (84.3% vs 83.8%, P = 0.94). There were no complications with either snare. Conclusion Snare type appears to be an important determinant of completeness of excision when removing small polyps by the cold snare technique. [ABSTRACT FROM AUTHOR]

Endoscopic papillectomy has become the mainstay treatment in early papillary neoplasia. However, local recurrence remains the Achilles heel of the procedure due to the complex anatomy and limited ductal involvement unappreciated on endoscopic ultrasound (EUS) and/or endoscopic retrograde cholangiopancreatography (ERCP). While re-do papillectomy is, in general, technically feasible and widely accepted to treat recurrent adenoma, re-redo procedures to this end have rarely been reported. Likewise, utilization of cold snare technology is rarely considered in papillectomy and has, in fact, only once been reported in the literature before. We present a unique clinical case with a highly atypical growth pattern with a bonnet-like pedunculated lesion with a small insertion point just at the pancreatic duct orifice treated by re-redo cold snare papillectomy. How to cite this article: Zimmer V, Emrich K. Cold Snare Papillectomy for Re-redo Endoscopic Resection of a Defiant Adenoma Recurrence with a Unique Growth Pattern. Euroasian J Hepato-Gastroenterol 2021;11(1):43-44., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.)

Polyps in the upper and lower gastrointestinal tract can be premalignant or malignant lesions that can be treated endoscopically in early stages to prevent morbidity and more invasive procedures. This article critically reviews the techniques available and provides recommendations for endoscopic polypectomy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background/Aims Cold snare polypectomy (CSP) and jumbo forceps polypectomy (JFP) have been shown to be effective for removing diminutive colorectal polyps (DCPs) (5 mm). However, no study has compared complete resection rates between CSP and JFP for DCPs. The aim of this study was to compare the efficacy and safety of JFP with CSP for the removal of DCPs. Methods This was a prospective randomized controlled trial from two tertiary-care referral centers. A total of 1003patients were screened, and 169 patients with 196 DCPs were enrolled. The main outcome was complete polyp resection rate. Results Of 196 diminutive polyps, 177 (90.3%) were adenomatous polyps. The overall complete resection rate was 92.1% (163/177). The complete resection rate was not significantly different between JFP and CSP groups (92.0% vs 92.2%, P Z .947). JFP achieved complete resection rates comparable with CSP for polyps >3 mm (90.3% vs 89.8%, P Z .928). Polypectomy procedure time, tissue retrieval rate, and rate of postpolypectomy adverse events were not significantly different between the two groups. Conclusions Both JFP and CSP achieved complete resection rates of >90% for DCPs. Thus, JFP may be considered for polypectomy of DCPs. (International clinical trial registry number: KCT0002805) [ABSTRACT FROM AUTHOR]

Cold resection for small colonic polyps, and larger lesions, is being rapidly and widely adopted. Driven by an impressive safety and cost profile compared with conventional polypectomy, these advantages are offset by the limitations of smaller and shallower resection, and absent thermal effects that may permit persistence of residual neoplasia. To overcome this, optimal cold snare technique requires inclusion of a margin of normal mucosa and a piecemeal resection technique for larger polyps. This article examines the fundamentals of cold snare resection and evidence for its application, theorizes on limits to its application, and identifies areas for further research., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Diminutive colorectal lesions are polyps and flat lesions 1 to 5 mm in size, and small are 6 to 9 mm in size. The best resection method is the cold snare. Cold forceps are acceptable for 1- to 3-mm lesions, but should not be used to piecemeal polyps. Cold snaring has few complications and is more effective than cold forceps for 4- to 5-mm polyps and as effective and more efficient than hot snaring for 6- to 9-mm polyps., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background and Aims: Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (> 10 mm)., Patients and Methods: This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated > 10 mm, underwent CSP., Results: A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%), > 30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haemostasis occurred. In only one patient haemostatic clipping was required (in order to achieve hemostasis). Preventive clipping was used in 3 patients. There were no complications. Seventy-two patients (with 87 lesions) had a follow-up colonoscopy. Of these 87 lesions, 9 had residual adenomatous tissue (10.3 %). According to the size of the original polyp, the distribution was as follows: 11-19 mm : 2/36 (5.5 %), 20-29 mm : 4/32 (12.5 %), > 30 mm : 3/19 (15.7%)., Conclusion: CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe., Competing Interests: The authors declare that they have no conflict of interest, (© Acta Gastro-Enterologica Belgica.)

Objective: To compare the effect of cold snare and hot snare on the resection of small colorectal polyps, and to explore the clinical value of cold snare technique in removing colorectal polyps. Methods: From September 1, 2017 to January 31, 2018, 206 cases of patients with colorectal polyp resection in the Department of Gastroenterology of Peking University International Hospital were studied. During this period, according to the standard, 103 cases of patients (158 polyps) were in the cold snare group, and 103 patients (180 polyps) were randomly selected as control group from patients of the hot snare group. The related clinical data were analyzed retrospectively. The location, shape, size, polypectomy time, pathological type, complete resection rate, specimen recovery rate, complications and related costs of the two groups of polyps were compared. Results: The polypectomy time of the cold snare group was shorter than that of the hot snare group.The difference was statistically significant ( Z =-11.727, P <0.001). The related cost of the perioperative period of the cold snare group was lower than that of the hot snare group.The difference was statistically significant ( Z =-12.680, P <0.001). There were no statistically significant differences in the number of polyps/case, size, shape, pathological classification, complete resection rate, specimen recovery rate, and perioperative complications of the patients in the two groups( P >0.05). Conclusions: The operation time of cold snare technique in colorectal polyps (6-9 mm in diameter) is shorter and the cost is lower, which is worthy of clinical promotion.

There are several approaches to polypectomy for sessile polyps <20 mm and for pedunculated polyps. Recent evidence is leading towards standardisation of polypectomy technique. Key recent polypectomy developments include: 1. Use of cold snare polypectomy (CSP) for sessile polyps <10 mm; 2. Use of hot snare polypectomy (HSP) following submucosal injection for sessile polyps sized 10-19 mm; 3. Piecemeal cold snare polypectomy (PCSP), with or without prior submucosal injection, for select sessile polyps sized 10-19 mm, where the potential risk for an adverse event is increased (e.g. polyps in the caecum or ascending colon, or patients with increased risk of post-polypectomy bleeding), and where the risk of submucosal invasion is low; 4. Avoidance of hot biopsy forceps (HBF); 5. Limiting the use of cold biopsy forceps (CBF) to the smallest of diminutive polyps, where CSP is not feasible; 6. Mechanical haemostasis prior to polypectomy for large pedunculated polyps with head ≥20 mm or stalk ≥10 mm., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The objective was to assess the safety and outcome of cold snare technique used by flexible bronchoscopy in the treatment of airway benign neoplasms. The clinical data of 21 patients, who had airway benign neoplasm and were treated through the cold snare method in Sir Run Run Shaw Hospital, affiliated with the Zhejiang University, were retrospectively analyzed. The relief of the symptoms and occurrence of complications were observed and evaluated. All the tumors were benign and removed by cold snare. Postoperatively, we found that the treatment was completely effective in 12 patients, and there was a significant improvement in 7 patients and a moderate improvement in 2 patients, and no recurrence in follow-up visit. In conclusion, the cold snare technique is an economically feasible, safe, and effective method in the treatment of airway neoplasms.

Colonoscopic polypectomy is fundamental to effective colonoscopy. Through its impact on the polyp-cancer sequence, colonoscopic polypectomy reduces colorectal cancer incidence and mortality. Because it eliminates electrosurgical risk, cold snaring has emerged as the preferred technique for most small and all diminutive polyps. Few clinical trial data are available on the effectiveness and safety of specific techniques. Polypectomy technique seems highly variable between endoscopists, with some techniques more effective than others are. Further research is needed to investigate operator variation in polypectomy outcomes and establish an evidence base for best practice., (Copyright © 2013 Elsevier Inc. All rights reserved.)