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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]

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

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]

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.)

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.)