Cold versus hot snare polypectomy for pedunculated colorectal polyps: a multicenter randomized controlled trial.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Cold snare polypectomy (CSP) is recognized for reducing delayed postpolypectomy bleeding (DPPB) in colorectal polyp resection.
• Evidence from randomized controlled trials (RCTs) comparing CSP and hot snare polypectomy (HSP) for pedunculated polyps is limited.
• This study addresses the need for robust RCT data on the safety of CSP versus HSP.

Purpose of the Study:

• To compare the safety and efficacy of CSP against HSP for removing pedunculated colorectal polyps.
• To evaluate the primary outcome of delayed postpolypectomy bleeding (DPPB) within 30 days.
• To assess secondary outcomes including immediate bleeding, adverse events, and procedure time.

Main Methods:

• A prospective, multicenter, single-blind randomized controlled trial (RCT) was conducted.
• Pedunculated colorectal polyps with specific size criteria (heads <20 mm, stalk thickness ≤5 mm) were included.
• Participants were randomized to either CSP or HSP, with DPPB as the primary endpoint.

Main Results:

• A total of 189 polyps were analyzed (94 CSP, 95 HSP).
• CSP demonstrated a significantly lower risk of DPPB (0% vs. 6.3%) compared to HSP.
• CSP was associated with increased immediate bleeding (86.2% vs. 12.6%) but no severe adverse events, and a shorter polypectomy time (25.0 vs. 57.0 seconds).

Conclusions:

• CSP is associated with reduced delayed bleeding risk compared to HSP for specific pedunculated colorectal polyps (heads ≤15 mm, stalks ≤5 mm).
• The increased immediate bleeding with CSP requires careful management but does not appear to lead to severe complications.
• Further research is needed to clarify the safety and efficacy of CSP for larger polyps (heads 16-19 mm).