Hot and Cold Polypectomy Techniques in Children: A 13-Year Comparative Study of 2,000 Polyps

Pediatric polypectomy is routine, yet no prior study has directly compared cold forceps (CFP), hot forceps (HFP), cold snare (CSP), and hot snare polypectomy (HSP). This study evaluated techniques, polyp characteristics, and outcomes.

We retrospectively reviewed patients aged 0-20 years who underwent polypectomy at Riley Hospital for Children from 2/2012-7/2025. Demographic, morphologic, histologic, and outcome data were analyzed at procedure and polyp levels.

Across 320 procedures, 2,000 polyps were removed from 203 patients (mean age, 9.5 ± 5.2 years). Polyps were predominantly colorectal, with gastric lesions the most common upper gastrointestinal location. HSP was most common (67.2%), followed by CFP (40.6%), CSP (21.6%), and HFP (1.6%). Beginning in 2020, CSP use increased while CFP/HSP declined. Sessile/flat polyps were predominantly removed with CFP/CSP, whereas pedunculated lesions were almost exclusively resected with HSP. Adenomas were the most common histology overall, predominantly removed with CFP/CSP; juvenile polyps with HSP. No perforations occurred. Immediate bleeding requiring endoscopic therapy occurred in 8.7% of CSP, 2.8% of HSP, and 0.8% of CFP cases. Delayed bleeding occurred only after HSP cases (1.4%). Recurrence in patients without hereditary polyposis syndromes occurred exclusively after CFP, including two adenomas.

Pediatric polypectomy outcomes paralleled adult trends, with higher immediate bleeding after CSP, delayed bleeding after HSP, and recurrence exclusively after CFP. Technique selection reflected distinct pediatric morphology and histology. These findings support the safety and feasibility of CSP, reinforce caution with CFP, and provide benchmark data to inform pediatric polypectomy practice and future guideline development.