Cold Versus Hot Snare Polypectomy for Small Colorectal Polyps : A Pragmatic Randomized Controlled Trial

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Colorectal Cancer Screening

Background:

• Cold snare polypectomy (CSP) is suggested to reduce bleeding risk, but robust evidence in the general population is limited.
• Delayed post-polypectomy bleeding is a significant concern following endoscopic mucosal resection.

Purpose of the Study:

• To compare the efficacy of cold snare polypectomy (CSP) versus hot snare polypectomy (HSP) in reducing delayed bleeding after colorectal polypectomy.
• To evaluate the safety and effectiveness of CSP in a large, general patient population.

Main Methods:

• A multicenter, randomized controlled trial involving 4270 participants aged 40 years or older with colorectal polyps measuring 4 to 10 mm.
• Participants underwent either cold snare polypectomy (CSP) or hot snare polypectomy (HSP).
• The primary outcome was the rate of delayed bleeding within 14 days post-procedure, with secondary outcomes including procedure time and resection success.

Main Results:

• Delayed bleeding occurred in 0.4% of the CSP group versus 1.5% in the HSP group, indicating a significantly lower risk with CSP.
• Severe delayed bleeding events were also substantially reduced in the CSP group (0.05% vs. 0.4%).
• CSP procedures were associated with shorter mean polypectomy times and fewer emergency service visits compared to HSP.

Conclusions:

• Cold snare polypectomy (CSP) is a safer alternative to hot snare polypectomy (HSP) for removing small colorectal polyps, significantly decreasing the incidence of delayed bleeding.
• The findings support the broader adoption of CSP for improved patient safety in polypectomy procedures.