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Cold Snare Safer Than Hot Snare for 4- to 10-mm Colorectal Polyps in Pragmatic Randomized Controlled Trial

Douglas K. Rex, MD, MASGE reviewing Chang LC, et al. Ann Intern Med 2023 Feb 21.

Cold snare polypectomy is now widely accepted as the treatment of choice for colorectal polyps 4 to 10 mm in size. Despite overwhelming evidence that cold techniques are safer than hot techniques, there are not data from randomized trials in the general population with enough power to show a difference in delayed hemorrhage for 4- to 10-mm polyps.

In a pragmatic randomized controlled trial from Taiwan, 4270 patients with one or more colorectal polyps 4 to 10 mm in size were randomly assigned to cold versus hot snare polypectomy. Overall delayed bleeding was less common with cold snare (0.4%) versus hot snare (1.5%). Severe bleeding occurred in only one patient in the cold snare group (0.05%) versus 8 patients (0.4%) with hot snare. The mean polypectomy time was shorter with cold snare, and there were no differences in the rates for tissue retrieval, en bloc resection, and complete histologic resection. Emergency department visits were lower with cold snare than hot snare (4 [0.2%] vs 13 [0.6%]).


These data provide important support for the use of cold snare polypectomy as the treatment of choice for endoscopic resection of 4- to 10-mm polyps.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Chang LC, Chang CY, Chen CY, et al. Cold versus hot snare polypectomy for small colorectal polyps: a pragmatic randomized controlled trial. Ann Intern Med 2023 Feb 21. (Epub ahead of print) (