Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial

Abstract

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).

Complete polyp resection with cold snare versus hot snare polypectomy for polyps of 4–9 mm: a randomized controlled trial

“…Our observed difference between the cold and hot snare groups of 3.2% incomplete resection rate is in line with previous trials and a recent meta-analysis, reporting rate differences between 0.5% and 7.0%. [16][17][18][19][24][25][26].…”

Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

“…CSP is a simple and quick procedure that does not involve submucosal injection or electrocautery and has the same complete resection rate and bleeding rate as of hot snare polypectomy. 8 We considered CSP to be suitable for small duodenal lesions and it had been introduced for SNADETs in 2015 at our institution. 9 Maruoka et al 10 reported the safety and efficacy of cold polypectomy (CP, CSP, and cold forceps polypectomy) for sporadic SNADETs.…”

Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

“…Two of the trials assessed CSP vs. HSP. 16,17 One of them included HS-EMR (44%) in HSP. 16 The other three trials compared either one method to another (CSP vs. HS-EMR, 18 CS-EMR vs. HS-EMR 19 ) or compared all three methods (CSP vs. CS-EMR vs. HS-EMR).…”

“…20 In the two RCTs that compared CSP and HSP, the completeness of resection was assessed by two biopsies from the margin of the mucosal defect after polypectomy; the RCTs revealed comparable CRRs between CSP (92.5-97.2%) and HSP (94-97.4%). 16,17 In the two RCTs comparing CSP and HS-EMR, the completeness of resection was assessed by 3-5 biopsies from the margin and base of the mucosal defect after polypectomy; statistically, the CRRs in HS-EMR (95.5-98.5%) were significantly better than those in CSP (81.6-91.5%). 18,20 In the two RCTs comparing CS-EMR and HS-EMR, the completeness of resection was assessed by 3-5 biopsies also from the margin and base of the mucosal defect after polypectomy, and the CRRs were observed to be comparable between CS-EMR (92.1-93.1%) and HS-EMR (93.3-95.3%).…”