Abstract
Background
Cold snare polypectomy (CSP) is recommended for the resection of small colorectal polyps. However, few studies have investigated the efficacy of cold endoscopic mucosal resection (cold EMR) for small polyps. Thus, the aim of this study was to investigate the efficacy and safety of cold EMR compared with CSP for small colorectal polyps.
Methods
This was a multicenter, randomized trial conducted in three tertiary centers from January 2018 to February 2021. Patients with polyps sized 6–10 mm were randomized to CSP or cold EMR group. After polypectomy, two additional biopsies were performed to assess the completeness of resection. The primary outcome was complete polyp resection rate. Secondary outcomes were total procedure time and rate of adverse events such as immediate bleeding, delayed bleeding, and perforation.
Results
A total of 444 polyps in 327 patients were assessed and randomly assigned to each group. Of those, 425 polyps were finally analyzed based on pathology results. The complete resection rate was not significantly different between cold EMR and CSP groups (91.9% vs 89.8%, p = 0.24). However, the total procedure time was significantly increased in cold EMR (87.6 s vs. 45.8 s, p < 0.001). The rate of polypectomy adverse events was not significantly different between the two groups. No patient had massive bleeding or perforation.
Conclusions
There was no difference in complete resection rate or adverse events between CSP and cold EMR. However, CSP reduced the total procedure time.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Horiuchi A, Ikuse T, Tanaka N (2019) Cold snare polypectomy: indications, devices, techniques, outcomes and future. Dig Endosc 31:372–377
Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49:270–297
Kawamura T, Takeuchi Y, Asai S et al (2018) A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial (CRESCENT study). Gut 67:1950–1957
Ichise Y, Horiuchi A, Nakayama Y et al (2011) Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps. Digestion 84:78–81
Suzuki S, Gotoda T, Kusano C et al (2018) Width and depth of resection for small colorectal polyps: hot versus cold snare polypectomy. Gastrointest Endosc 87:1095–1103
Horiuchi A, Hosoi K, Kajiyama M et al (2015) Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps. Gastrointest Endosc 82:686–692
McWhinney CD, Vemulapalli KC, El Rahyel A et al (2021) Adverse events and residual lesion rate after cold endoscopic mucosal resection of serrated lesions ≥ 10 mm. Gastrointest Endosc 93:654–659
Papastergiou V, Paraskeva KD, Fragaki M et al (2018) Cold versus hot endoscopic mucosal resection for nonpedunculated colorectal polyps sized 6–10 mm: a randomized trial. Endoscopy 50:403–411
Hewett DG, Kaltenbach T, Sano Y et al (2012) Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 143:599-607.e1
Wallace MB (2017) New strategies to improve polypectomy during colonoscopy. Gastroenterol Hepatol (N Y) 13:1–12
Rutter MD, Jover R (2020) Personalizing polypectomy techniques based on polyp characteristics. Clin Gastroenterol Hepatol 18:2859–2867
Horiuchi A, Makino T, Kajiyama M et al (2016) Comparison between endoscopic mucosal resection and hot snare resection of large nonpedunculated colorectal polyps: a randomized trial. Endoscopy 48:646–651
Li D, Wang W, Xie J et al (2020) Efficacy and safety of three different endoscopic methods in treatment of 6–20 mm colorectal polyps. Scand J Gastroenterol 55:362–370
Rameshshanker R, Tsiamoulos Z, Latchford A et al (2018) Resection of large sessile serrated polyps by cold piecemeal endoscopic mucosal resection: serrated COld piecemeal endoscopic mucosal resection (SCOPE). Endoscopy 50:E165-e167
Piraka C, Saeed A, Waljee AK et al (2017) Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. Endosc Int Open 5:E184-e189
Muniraj T, Sahakian A, Ciarleglio MM et al (2015) Cold snare polypectomy for large sessile colonic polyps: a single-center experience. Gastroenterol Res Pract 2015:175959
Tutticci NJ, Hewett DG (2018) Cold EMR of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc 87:837–842
Ito A, Suga T, Ota H et al (2018) Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol 53:1171–1178
Shimodate Y, Itakura J, Takayama H et al (2020) Impact of submucosal saline solution injection for cold snare polypectomy of small colorectal polyps: a randomized controlled study. Gastrointest Endosc 92:715-722.e1
Pohl H, Srivastava A, Bensen SP et al (2013) Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 144:74-80.e1
Shimodate Y, Mizuno M, Takezawa R et al (2017) Safety of cold polypectomy for small colorectal neoplastic lesions: a prospective cohort study in Japan. Int J Colorectal Dis 32:1261–1266
Yamashina T, Fukuhara M, Maruo T et al (2017) Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis. Endosc Int Open 5:E587-e594
Repici A, Hassan C, Vitetta E et al (2012) Safety of cold polypectomy for < 10mm polyps at colonoscopy: a prospective multicenter study. Endoscopy 44:27–31
Acknowledgements
The authors thank Eungyu Kim for her assistance with the research.
Funding
No financial relationship to declare.
Author information
Authors and Affiliations
Contributions
MJK, SYN, and JSK contributed toward study concept and design, and data collection. MJK and JSK contributed toward analysis and interpretation of the data, and drafting of the article. HHC, JSJ, BWK, and HC contributed toward critical revision of the article for important intellectual content. MJK, SYN, and JSK contributed toward final approval of the article.
Corresponding author
Ethics declarations
Disclosures
Drs. Min Ji Kim, Soo Young Na, Joon Sung Kim, Hyun Ho Choi, Dae Bum Kim, Jeong-Seon Ji, Byung-Wook Kim, and Hwang Choi have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kim, M.J., Na, S.Y., Kim, J.S. et al. Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a multicenter randomized controlled trial. Surg Endosc 37, 3789–3795 (2023). https://doi.org/10.1007/s00464-023-09875-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-023-09875-1