Comparison of cold and hot snaring polypectomy for small colorectal polyps: study protocol for a randomized...

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Colorectal cancer poses a significant healthcare challenge, often developing from adenomas.
• Colonoscopy with polypectomy is crucial for reducing colorectal cancer mortality and incidence.
• Cold snare polypectomy is a time-saving technique for polyps <10 mm, but its superiority over hot snare polypectomy in preventing delayed bleeding is unproven due to small sample sizes in prior trials.

Purpose of the Study:

• To compare the risk of delayed bleeding after cold versus hot snare polypectomy in a large patient cohort.
• To evaluate the efficacy and safety of cold snare polypectomy for small colorectal polyps.

Main Methods:

• A prospective, multicenter, randomized controlled trial involving 4258 patients with small polyps (4-10 mm).
• Patients were randomized 1:1 to undergo either cold or hot snare polypectomy performed by experienced endoscopists.
• Primary outcome: risk of delayed bleeding. Secondary outcomes: hemoclip use, complete eradication rates, procedure time, and adverse events.

Main Results:

• Delayed bleeding risk following cold snare polypectomy compared to hot snare polypectomy.
• Complete eradication rates confirmed optically and histologically.
• Procedure time and adverse event rates, including immediate bleeding and perforation.

Conclusions:

• Cold snare polypectomy is hypothesized to reduce delayed bleeding risk by avoiding thermal injury.
• The study aims to demonstrate cold snare polypectomy as a safe, effective, and economic option for small colorectal polyps.
• Results will inform clinical recommendations for treating small colorectal polyps.