Hot versus cold snare polypectomy for colorectal polyps: current evidence and practical guide for decision-making

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Colorectal polyps necessitate endoscopic removal.
• Cold and hot snare techniques differ in electrocautery use, safety, and resection depth.

Purpose of the Study:

• To review evidence comparing cold and hot snare resection techniques.
• To provide a framework for selecting the appropriate polypectomy method.

Main Methods:

• Systematic review of current evidence.
• Analysis of guidelines and randomized trials.

Main Results:

• Cold snare polypectomy (CSP) is recommended for polyps ≤10 mm due to safety and low bleeding risk.
• For 10-19 mm lesions, technique choice depends on histology/morphology; hot snare polypectomy (HSP) for specific types, CSP/cold endoscopic mucosal resection (EMR) for others.
• Hot EMR with margin treatment is standard for large adenomatous polyps (≥20 mm); cold EMR offers reduced thermal injury but higher recurrence.

Conclusions:

• CSP is the preferred method for most small colorectal polyps.
• Larger polyps require individualized technique selection based on histology, morphology, and invasion risk.
• Further long-term data are needed on recurrence and cancer risk for different resection strategies.