Cold and Hot Snaring for Colorectal Polyps

The resection of colorectal polyps has diversified in recent years. Nowadays, a variety of techniques exist, including forceps and snare resection without or with prior submucosal injection (endoscopic mucosal resection [EMR]), as well as without or with diathermy current ("cold" or "hot"). Other options include underwater EMR (U-EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection. When discussing resection techniques, the endpoints of safety (e.g., perforation or delayed bleeding) and effectiveness (e.g., residual/recurrent adenoma) should be considered.

The current evidence-based roles of various resection techniques are provided. Additional measures, such as margin coagulation and clip closure of the resection site, are also discussed.

Cold snare resection should be performed for small polyps (≤9 mm) and sessile-serrated lesions without dysplasia of any size due to its beneficial safety profile and satisfactory effectiveness. Polyps ≥20 mm should be treated with the hot snare, as it is more effective, particularly in case of piecemeal resection with additional margin coagulation. U-EMR is an option to optimize effectiveness for the removal of polyps measuring 20-40 mm. Potentially malignant polyps are best removed en bloc by ESD. The future role of cold snare resection with margin coagulation for large low-grade adenomas is subject of ongoing studies.