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The Japan Gastroenterological Endoscopy Society published the latest English versions of the guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for colorectal neoplastic lesions and colorectal cold polypectomy in 2020 and 2022, respectively. In this article, I present a comprehensive overview of these guidelines, including a comparison with the Western recommendations.

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]

Objective To evaluate the safety and efficacy of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) in the treatment of small colorectal polyps. Methods The clinical data of 3 750 patients who underwent endoscopic polypectomy for small colorectal polyps in our hospital from January 1, 2020 to August 31, 2021 were collected and analyzed retrospectively. There were 1 796 cases assigned into CSP group and 1 954 cases into HSP group. Their general data, number and utilization rate of titanium clips, complete resection rate, specimen recovery rate, incidence of delayed bleeding, perforation rate and incidence of abdominal discomfort were analyzed and compared between the 2 groups. Results There were no significant differences in the general data (age, gender, BMI, and number, size, location, morphology and pathological type of polyps) and in proportions of comorbidities (hypertension and diabetes) between the 2 groups (P>0.05). The utilization rate and average number of clips used were significantly lower in the CSP group than the HSP group (11.19% vs 19.55%, P < 0.001; 0.16±0.49 vs 0.27±0.63, P < 0.001). No statistical difference was found in the complete resection rate between the 2 groups (93.99% vs 95.04%, P=0.158). The CSP group had higher specimen recovery rate (99.55% vs 98.26%, P < 0.001), lower incidence of delayed bleeding (0.06% vs 0.46%, P=0.037) and incidence of abdominal discomfort (4.18% vs 9.31%, P < 0.001) when compared with the HSP group. In terms of perforation, no occurrence was observed in the CSP group and 1 case (0.05%) in the HSP group, though no statistical difference (P=0.521). Conclusion When compared with HSP, CSP has advantages of lower utilization rate and less number of titanium clips, higher specimen recovery rate, and lower incidence of complications in the treatment of small colorectal polyps. It is a safe and effective treatment, and worthy of clinical application.

Backgound: Cold snare polypectomy (CSP) can minimize the risk of adverse events and has become a standard treatment for small colorectal polyps. CSP might also be suitable for small superficial non-ampullary duodenal epithelial tumors (SNADETs). This study aimed to evaluate the safety of CSP for SNADETs. Methods: The major indication criteria were as follows: (1) endoscopically diagnosed SNADET, (2) ≤ 10 mm, and (3) a single primary lesion. CSP was performed using an electrosurgical snare without electrocautery. Follow-up endoscopy and scar biopsy were performed 3 months after CSP. The primary endpoint was the delayed adverse events rate. Results: In total, 21 patients were enrolled. Two and 19 lesions were located in the duodenal bulb and 2nd portion, respectively; the median lesion size was 8 mm. CSP was attempted for all lesions; three lesions could not be resected without electrocautery and were removed by conventional endoscopic mucosal resection (EMR). The rate of spurting bleeding after CSP was 0%. The median procedure time was 12 min, the median resected specimen size was 12 mm, and the rate of en bloc resection was 81% (17/21). No adverse events were observed intraoperatively, with no delayed adverse events after CSP. Histopathology revealed 15 adenomas, 4 cancers (intramucosal), and 2 non-neoplastic lesions. The horizontal margins were negative/positive/undetermined in 9, 1, and 11 cases, respectively. All vertical margins were negative. Only one recurrence was detected by follow-up endoscopy 3 months after CSP. Conclusions: CSP can be performed safely for small SNADETs. Clinical trial registration: This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (http://www.umin.ac.jp/ctr/index.htm), and the registration number is UMIN000019157. [ABSTRACT FROM AUTHOR]

The Japan Gastroenterological Endoscopy Society published the second edition of the "Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front‐line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased. Herein, we establish supplementary guidelines for cold polypectomy. Considering that the level of evidence for each statement is limited, these supplementary guidelines must be verified in clinical practice. [ABSTRACT FROM AUTHOR]

Background and Aims: Colorectal polyps resected by cold snare polypectomy (CSP) are rarely diagnosed as colorectal cancer (CRC). We aimed to investigate the prevalence, clinical features, and prognosis of patients with CRC resected by CSP., Subjects: Patients with colorectal polyps treated with CSP between 2018 and 2022 were enrolled and regularly followed up (median observation period: 30.6 months). Logistic regression analysis and decision tree analysis were employed to investigate the clinical features of the patients., Results: A total of 5,064 colorectal polyps from 2,530 patients were resected by CSP. Of these, 0.24% were diagnosed as CRC; however, no patients died due to CRC. eGFR was an independent risk factor for the presence of CRC (unit 10, OR 0.716, 95%CI 0.525-0.973, P=0.0323) and its optimal cut-off value was 59.9 mL/min/1.73 m 2 . The decision-tree analysis revealed that 2.03% of patients with creatinine ≥ 1.0 mg/dL had CRC., Conclusion: CRC was diagnosed in 0.24% of the polyps; however, no patients died due to CRC. eGFR <60 mL/min/1.73 m 2 and creatinine >1.0 mg/dL were associated with CRC. Thus, colorectal polyps should be carefully examined in patients with chronic kidney disease.

Background and Aim: Cold snare polypectomy (CSP) is a safe treatment for colorectal adenomas. However, the R0 resection rate is not sufficiently high because of inadequate resection of muscularis mucosa. We hypothesized that CSP in an underwater environment could improve this procedure by helping to safely achieve resection containing the muscularis mucosa. We have named this procedure underwater cold snare polypectomy (UCSP). We aimed to investigate the efficacy and safety of UCSP for colorectal adenomas. Methods: Between May 2017 and April 2018, patients diagnosed with colorectal adenomas <9 mm underwent UCSP. After follow‐up colonoscopy 3 weeks later, the patients post‐UCSP scars were biopsied. Outcomes were compared with those of a historical control group who underwent conventional CSP in our previous study using propensity score‐matching methods. Results: Overall, 224 lesions in 65 patients were prospectively resected by UCSP. Pathologically, 209 lesions were adenomas (4.5 ± 1.5 mm) including one intramucosal carcinoma. Only one pathological residual adenoma was identified, but there was no significant difference in the residual rate between the UCSP and CSP groups (both 1.0%). No complications were observed. R0 resection rate and rate of area containing the muscularis mucosa in the UCSP group were significantly higher than those in the CSP group (80.2% vs 32.7%, P < 0.001; 50.0% vs 35.3%, P = 0.015). Conclusion: Underwater cold snare polypectomy for diminutive and small colorectal adenomas was safe and effective from the perspective of pathological complete resection, which is likely facilitated by achieving an adequate depth of resection. [ABSTRACT FROM AUTHOR]

Backgrounds: Recently, several studies have demonstrated the usefulness of cold polypectomy (CP), a safe and simple method for the removal of small polyps. We investigated the safety and efficacy of CP compared to that of endoscopic mucosal resection (EMR) and hot biopsy polypectomy (HB). Methods: We retrospectively examined 1713 colorectal polyps (size 1–9 mm) in 731 patients. CP, EMR, and HB were performed on 476, 997, and 240 lesions, respectively. We compared the region, size, morphology, the presence of delayed bleeding as overt bleeding 24 h after operation, number of clips, pathology, the presence of antithrombotic therapy, procedure time from detection of a polyp to resection and hemostasis, device cost including device and clips, and polyp remnants. Results: The delayed bleeding in the CP group (0/476) was significantly lower compared to that in the HB group (3/240) and EMR group (7/997). There were no cases of perforations. The procedure time was significantly shorter in the CP group than in the EMR group (91.3sec vs 290.1sec, p <.0001). The CP group had a significantly lower device cost than the HB and EMR groups (49.2USD vs 58.0 USD vs 91.3 USD, p <.0001) was not inferior in terms of polyp remnants to the EMR and HB groups. (1.4% vs 0.6% vs 6.1%, p =.1599) Conclusions: CP is a safe treatment that achieves less delayed bleeding. Moreover, CP is not inferior to other groups in terms of polyp remnants and offers a cost benefit. CP can be considered useful for colonic polypectomy. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic salvage treatment for recurrent or residual neoplasms is sometimes technically challenging, and information in choice of treatment methods is lacking. This study aimed to clarify the appropriate treatment strategy for local recurrence after endoscopic resection (ER).Methods: Seventy-four patients with 74 lesions who received endoscopic treatment for local recurrence after ER for colorectal epithelial neoplasms between January 2010 and December 2016 were enrolled. Patients with hyperplastic polyp, sessile-serrated adenoma/polyp, and submucosal invasive cancer in their initial ER were excluded. Treatment methods, treatment outcomes, and recurrence rate were evaluated for each recurrence based on the preoperative endoscopic diagnosis (adenomatous or cancerous).Results: Forty-nine of the 74 patients diagnosed with adenomatous recurrence were treated using cold polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) in 15, 26, and 8 patients, respectively. Cold polypectomy was applied only to diminutive lesions. EMR and ESD en bloc resection rates were 53.8 and 100%, respectively (p = 0.030). Two patients (7.7%) in the EMR group developed local recurrence, but an additional ER achieved complete resection. Meanwhile, the remaining 25 patients diagnosed with cancerous recurrence were treated via EMR and ESD for 7 and 18 patients, respectively. EMR and ESD en bloc resection rates were 28.6 and 83.3%, respectively (p = 0.017). Three patients (42.9%) in the EMR group developed recurrence.Conclusions: Selecting appropriate treatment methods for adenomatous recurrence could be decided based on estimated pathology and lesion size. ESD was effective for cancerous recurrence to achieve complete disease control. [ABSTRACT FROM AUTHOR]

Background/Aim: To compare the complete resection rate of hot and cold snare polypectomy for small colorectal polyps. Patients and Methods: We retrospectively reviewed the medical records of 233 consecutive patients with 461 colorectal polyps up to 10 mm in diameter that were treated by hot or cold snare polypectomy between April 2014 and August 2016. Lesions treated by hot snare polypectomy (n = 137) and cold snare polypectomy (n = 324) were compared. The histological complete resection rates were evaluated between the two groups. We analyzed the relationship between factors for complete resection and clinical factors using multivariate analysis. Results: There was a significantly higher complete resection rate in hot snare polypectomy than in cold snare polypectomy (70.5% vs. 47.3%; P < 0.001). In the analysis of subgroups categorized according to polyp size, the complete resection rate for hot snare polypectomy was significantly higher than that for cold snare polypectomy among polyps ≥6 mm (69.0% vs. 43.5%; P < 0.001). Among polyps ≤5 mm, no significant difference regarding the complete resection rate was observed between the methods (81.3% vs. 53.4%; P = 0.057). There was no significant difference in the incidence of adverse events between the two groups. Multivariate analysis revealed that using hot snare polypectomy (odds ratio 3.03; P < 0.001), small lesion size (odds ratio 1.57; P = 0.049), and lesion location in the left colon (odds ratio 1.73; P = 0.007) were independent factors for complete resection. Conclusion: Hot snare polypectomy provides a higher complete resection rate than does cold snare polypectomy for larger (6–10 mm) subcentimeter colorectal polyps.

The Japan Gastroenterological Endoscopy Society published the latest English versions of the guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for colorectal neoplastic lesions and colorectal cold polypectomy in 2020 and 2022, respectively. In this article, I present a comprehensive overview of these guidelines, including a comparison with the Western recommendations., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Copyright © 2024 The Japan Society of Coloproctology.)

Purpose: To examine the usefulness of non-magnified close observation with blue laser imaging (BLI) using a colonoscope with close observation capability in determining indications for cold polypectomy. Methods: We conducted an image evaluation study on 100 consecutive colorectal lesions of 10 mm or less which were observed endoscopically without magnification using BLI mode prior to treatment. Two experts and two non-experts reviewed the images using the Japan NBI expert team (JNET) classification and the diagnostic accuracy was analyzed. Results: The final pathological diagnoses of the 100 lesions were hyperplastic/sessile serrated polyp (HP/SSP), low grade dysplasia (LGD), high grade dysplasia (HGD) and deep submucosal invasive cancer (dSM), respectively, in 12, 79, 9 and 0 lesions. When JNET classification type 1 corresponds to HP/SSP; 2A to LGD; 2B to HGD; and 3 to dSM; the overall diagnostic accuracy was 84.3%. Accuracy was 90.5% for experts and 78.0% for non-experts. High confidence rate was 67.5% for experts and 48.0% for non-experts. In diagnostic accuracy for HGD, the sensitivity, specificity, PPV and NPV were, respectively, 77.8%, 98.9%, 87.5% and 97.8% for experts; and 66.6%, 92.3%, 46.2% and 96.6% for non-experts. Conclusions: The diagnostic accuracy of unmagnified close observation with BLI using a colonoscope with close observation capability is similar to that reported for magnifying endoscopy and is useful in predicting the histological diagnosis of colorectal polyps of 10 mm or less although the effectiveness may be limited for non-experts. This modality is a potentially useful tool in deciding indications for cold polypectomy. [ABSTRACT FROM AUTHOR]

Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication. [ABSTRACT FROM AUTHOR]

Background: Cold polypectomy has been widely accepted for removal of small colorectal polyps. However, no large-scale prospective study exists as for its safety in Japan. We investigated this issue in this single-center, prospective cohort study in a total of 1198 colorectal polyps resected with cold polypectomy. Patients and methods: Four hundred and seventy-four patients who underwent cold polypectomy for colorectal neoplastic lesions less than 10-mm diameter between September 2014 and October 2016 were enrolled. Primary outcome was the incidence of delayed bleeding within 2 weeks after the procedure. Secondary outcomes were the rate of immediate bleeding, perforation, endoscopic en bloc resection, and advanced histology. Results: Cold polypectomy was performed on 1198 polyps in the 474 patients. No delayed bleeding or colonic perforation was observed. Immediate bleeding during the procedure, requiring endoscopic hemostasis, occurred in 97 lesions (8.1%), and all of them were successfully managed endoscopically. The endoscopic en bloc resection rate was 97.2%. Twenty-eight lesions (2.3%) were histologically diagnosed as advanced neoplasia; among them, three lesions were well-differentiated adenocarcinomas, and in two of them, a negative margin was not histologically confirmed. Conclusions: Cold polypectomy for small colorectal polyps is a safe technique without significant complication, but careful endoscopic diagnosis at cold polypectomy is necessary to identify advanced neoplasia. The reliability of cold polypectomy in excision of polyps with high-grade neoplasia should be established before the procedure becomes standard in the excision of small colorectal polyps. Clinical trial registration number: UMIN000014812. [ABSTRACT FROM AUTHOR]

Diminutive polyps (<5 mm in diameter) represent the majority of polyps found during colonoscopy; about a half of them are adenomatous, with low risk of advanced neoplasia. Recent studies have demonstrated that cold polypectomy should be considered the recommended approach for resecting diminutive polyps and that cold snaring may be superior to cold forceps biopsy, at least for polyps of 4-5 mm. Recently, electronic chromoendoscopy has been applied to characterization of diminutive polyps to discriminate adenomatous from nonadenomatous lesions. Optical diagnosis of polyp histology could potentially exert huge cost savings by the 'resect and discard' strategy for diminutive polyps and 'leaving-in' for diminutive hyperplastic polyps in the recto-sigmoid colon. These policies represent the mainstay for adopting endoscopy-directed post-polypectomy surveillance strategies, endorsed by both American and European Endoscopy Societies. Accuracy of both histology and surveillance intervals predictions from academic centers have been encouraging, although the same performance has not been replicated in community practices. [ABSTRACT FROM AUTHOR]

Adequate colonoscopic polypectomy is a very important intervention for the prevention of colorectal cancer progression during screening and surveillance colonoscopy. Whereas various techniques are used for the removal of diminutive polyps, including cold biopsy forceps, hot biopsy forceps, hot snare, and cold snare, hot polypectomy techniques with electrocautery have been associated with an increased risk of electrocauteryrelated complications, including immediate and/or delayed bleeding or perforation. In contrast, recent studies have found a polypectomy technique without electrocautery, so-called cold polypectomy, to be a safer and more efficacious technique. The present article discusses the use of cold polypectomy techniques and describes how cold biopsy forceps polypectomy using jumbo biopsy forceps designed with a greater capacity for removing larger tissue samples, and cold snare polypectomy, are adequate for removing diminutive polyps completely and safely and shorten withdrawal time of the colonoscopy procedure. [ABSTRACT FROM AUTHOR]

Background: Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice., Aim: To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching., Methods: We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records., Results: After propensity score matching, there were no significant differences in the patients' and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group ( P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference ( P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group., Conclusion: Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest for this article., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Backgrounds: Recently, several studies have demonstrated the usefulness of cold polypectomy (CP), a safe and simple method for the removal of small polyps. We investigated the safety and efficacy of CP compared to that of endoscopic mucosal resection (EMR) and hot biopsy polypectomy (HB). Methods: We retrospectively examined 1713 colorectal polyps (size 1-9 mm) in 731 patients. CP, EMR, and HB were performed on 476, 997, and 240 lesions, respectively. We compared the region, size, morphology, the presence of delayed bleeding as overt bleeding 24 h after operation, number of clips, pathology, the presence of antithrombotic therapy, procedure time from detection of a polyp to resection and hemostasis, device cost including device and clips, and polyp remnants. Results: The delayed bleeding in the CP group (0/476) was significantly lower compared to that in the HB group (3/240) and EMR group (7/997). There were no cases of perforations. The procedure time was significantly shorter in the CP group than in the EMR group (91.3sec vs 290.1sec, p  < .0001). The CP group had a significantly lower device cost than the HB and EMR groups (49.2USD vs 58.0 USD vs 91.3 USD, p  < .0001) was not inferior in terms of polyp remnants to the EMR and HB groups. (1.4% vs 0.6% vs 6.1%, p  = .1599) Conclusions: CP is a safe treatment that achieves less delayed bleeding. Moreover, CP is not inferior to other groups in terms of polyp remnants and offers a cost benefit. CP can be considered useful for colonic polypectomy.

This is a comment on a meta-analysis of published studies comparing cold vs hot polypectomy. We believe that the conclusion of this meta-analysis that "cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy" needs more rigorous evidence., Competing Interests: Conflict-of-interest statement: The authors declare no conflicts of interest in association with this paper.

Aim: To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events., Methods: A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords "cold polypectomy". RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients' demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias., Results: Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group., Conclusion: Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.