Cold Versus Hot Snare Endoscopic Resection of Large Nonpedunculated Colorectal Polyps: Randomized Controlled German...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Endoscopic mucosal resection (EMR) is the standard treatment for large nonpedunculated colorectal polyps (≥20 mm).
• The safety and efficacy of cold resection versus hot resection (using cutting/coagulation current) for these polyps remain under investigation, with limited randomized trial data.
• Previous suggestions indicate cold resection may reduce adverse events compared to hot resection.

Purpose of the Study:

• To compare the safety and efficacy of cold endoscopic mucosal resection (EMR) versus hot EMR for large nonpedunculated colorectal polyps (≥20 mm) in a randomized controlled trial.
• To evaluate the primary outcome of major adverse events (AEs) and secondary outcomes including perforation, postendoscopic bleeding, postpolypectomy syndrome, and residual adenoma.
• To identify predictors of adverse events and residual adenoma in large colorectal polyps.

Main Methods:

• A multicenter, randomized controlled trial involving 19 centers was conducted.
• Nonpedunculated colorectal polyps ≥20 mm were randomized to either cold EMR or hot EMR.
• The primary outcome was major adverse events (perforation or postendoscopic bleeding); secondary outcomes included postpolypectomy syndrome and residual adenoma.

Main Results:

• Major adverse events occurred in 1.0% of the cold resection group versus 7.9% in the hot resection group (P=.001).
• Rates of perforation (0% vs 3.9%, P=.007) and postendoscopic bleeding (1.0% vs 4.4%, P=.040) were significantly lower in the cold group.
• Residual adenoma rates were higher after cold resection (23.7%) compared to hot resection (13.8%) (P=.020).

Conclusions:

• Cold resection of large, nonpedunculated colorectal polyps is significantly safer than hot EMR, with fewer major adverse events.
• The benefit of reduced adverse events with cold resection comes at the cost of a higher rate of residual adenoma.
• Further research is needed to determine how polyp size and histology can guide individualized treatment approaches for colorectal polyps.