Background and aims: Currently available resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). We aimed to compare CSP vs HSP in 5-9 mm polyps in terms of complete resection and adverse events rates. Methods: Multicenter, randomized trial conducted in 7 Spanish centers between February-November 2019. Patients with ≥1 5-9mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polyp removal, two marginal biopsies were submitted to a single pathologist blind to polyp histology. Complete resection was defined as the only finding of normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without <5mm or >9mm polyps. Results: A total of 496 subjects were randomized; 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5% with CSP and 94% with HSP (difference 1.5%, 95%CI: 4.9% to -1.9%). Intraprocedural bleeding appeared in 3 (0.8%) CSPs and 7 (1.8%) HSPs (p=0.34). One (0.3%) lesion per group presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (18.8% in CSP vs 18.4% in HSP), but, after 5 hours, it was higher in HSP group (5.9% vs 16,5%, p=0.02). CSP presented a higher proportion of asymptomatic patients 24h after the procedure than HSP, 97% vs 86.4% (p=0.01). Conclusions: We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduces the intensity and duration of post-colonoscopy abdominal pain (ClinicalTrials.gov number: NCT03783156).

Background There are few large prospective cohort studies evaluating predictors of outcomes in acute pancreatitis. Objectives The purpose of this study was to determine the role of age and co-morbid disease in predicting major outcomes in acute pancreatitis. Methods Data points were collected according to a predefined electronic data collection form. Acute pancreatitis and its complications were defined according to the revised Atlanta classification. Univariable and multivariable analyses were conducted using Cox proportional hazard regression and multiple logistic regression. Results From June 2013–February 2015, 1655 adult patients were recruited from 23 centres across Spain. Co-morbid disease, obesity, open surgical necrosectomy within 30 days, and pancreatic necrosis were independently associated with both 30-day mortality and persistent organ failure ( p < 0.05 for all). Age was not associated with persistent organ failure, however the extreme of age (>85 years) was associated with mortality ( p < 0.05). Co-morbid disease and obesity were not independently associated with a prolonged length of stay or other markers of morbidity on adjusted analysis ( p > 0.05). Conclusion Comorbidity and obesity are important determinates of mortality and persistent organ failure in acute pancreatitis, but in the absence of organ failure they do not appear to independently contribute to morbidity. This has important implications for severity classification and predictive models of severity in acute pancreatitis.

Introduction: Colorectal cancer (CRC) can present with luminal obstruction. Preoperative colonic stenting as a bridge to surgery is often considered and may allow for

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