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Published on: March 24, 2023
Cold snare polypectomy for 10-19 mm colorectal adenomas in familial adenomatous polyposis: a prospective randomized
Binbin Xu1,2, Xingjie Gao1, Linfu Zheng1
1Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Background And Aims:
Evidence for cold snare polypectomy (CSP) in treating 10-19 mm colorectal adenomas in patients with familial adenomatous polyposis (FAP) is limited. This study compared the efficacy and safety of CSP vs. hot snare polypectomy (HSP).
Methods:
This prospective non-inferiority randomized controlled trial predefined a non-inferiority margin of 4%. A total of 452 colorectal adenomas (10-19 mm) from 41 FAP patients were enrolled between May 2024 and May 2025 and randomized 1:1 to CSP (n = 220) or HSP (n = 232). The primary endpoint was histological complete resection (R0). Subgroup analyses were performed by lesion size (10-15 mm vs. 16-19 mm).
Results:
R0 resection rates were similar between CSP and HSP (92.3% vs. 92.7%, p = 0.76). CSP was associated with shorter procedure time (4.53 ± 1.18 vs. 6.53 ± 1.46 min, p < 0.01) and lower hospitalization costs (p < 0.01). Intra-procedural bleeding was more frequent with CSP, whereas delayed bleeding and post-polypectomy electrocoagulation syndrome were more common with HSP. At 6 months, recurrence was rare (one lesion in each group). No significant interaction by lesion size was observed.
Conclusions:
CSP is non-inferior to HSP for R0 resection of 10-19 mm colorectal adenomas in FAP patients and offers advantages in efficiency, safety and cost.
