Cold Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors: Current Evidence and Clinical Perspectives

Superficial non-ampullary duodenal epithelial tumors (SNADETs) are increasingly treated with endoscopic resection. Although conventional thermal techniques are effective, the thin duodenal wall and distinctive anatomy have driven interest in cold resection techniques that avoid electrocautery-related injury. This narrative review individually appraises cold snare polypectomy (CSP), cold forceps polypectomy (CFP), and cold snare endoscopic mucosal resection (CS-EMR) for duodenal SNADETs. Management of selected small low-grade adenomas should be individualized, with careful surveillance considered as an alternative to immediate resection. When resection is chosen, CSP is the principal cold resection technique for lesions <10 mm that are optically diagnosed as low-grade adenomas using white-light imaging and narrow-band imaging. CSP appears technically feasible and safe for selected small SNADETs. However, its shallow resection depth limits vertical margin assessment. Available follow-up data suggest low recurrence rates, and recurrent lesions are generally small and endoscopically manageable. This review also discusses the importance of pretreatment optical diagnosis, appropriate lesion selection, technical considerations, and structured surveillance after cold resection. CFP may be considered for carefully selected diminutive lesions, although the supporting evidence remains limited. Although CS-EMR can enable resection of larger lesions, substantial recurrence rates and the reported risk of perforation argue against its routine use. Overall, CSP is the principal cold resection technique for selected small low-grade adenomas, whereas CFP and CS-EMR have more limited roles.