Resection Techniques for Small Colonic Polyps: Cold Forceps Polypectomy, Hot Biopsy, Cold Snare and Hot Snare

Endoscopic Features of Normal and Abnormal Gastric Mucosa

“…In contrast to the hot snare technique, cold snare polypectomy is carried out without the electrical current, thereby avoiding all the complications that may arise in the hot snare technique. However, cold snaring is associated with higher chances of bleeding [32].…”

Hot avulsion versus argon plasma coagulation for the management of the non‐ensnarable polyp: A multicenter, randomized controlled trial

“…3 Hot avulsion (HA) is a likely safer variation of the welldescribed hot biopsy (HB) technique for polyp removal. [9][10][11][12] It entails the avulsion of neoplastic tissue using HB forceps and thermal energy. Unlike HB, HA is performed using a cutting or soft coagulation current, which results in less thermal injury to deeper layers of the colon.…”

“…Hot avulsion (HA) is a likely safer variation of the well‐described hot biopsy (HB) technique for polyp removal 9–12 . It entails the avulsion of neoplastic tissue using HB forceps and thermal energy.…”

How to treat diminutive polyps? Do we need more evidence?

“…These lesions have traditionally been considered low risk, and therefore low risk methods to resect them – that is, cold techniques – have increasingly been favored. Hot biopsy is more difficult to justify, given the risks for bleeding and late perforation and the supportive data against hot biopsy derived from animal models 6 7 . There is also a requirement to retrieve tissue for pathology to allow a determination of correct surveillance intervals; however, retrieving small polyps is a challenge, and the use of hot techniques can lead to tissue destruction, rendering pathologic assessment impossible.…”

“…Again, this may reflect the small number but sits in stark contrast to the high rates for sessile serrated adenomas. The failure of cold forceps polypectomy with multiple bites in polyps up to 5 mm in size is unsurprising, and a salutary lesson is that resection with this technique generally should be limited to polyps that can be completely engulfed in the cups of the biopsy forceps in a single bite – that is, polyps less than 2.8 mm in size 7 14 . However, the failure of cold snaring despite optimal technique, with a small rim of normal tissue left, is more surprising and suggests that we may also need to review this technique as more data become available.…”