Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size

Abstract

Cold snare polypectomy (CSP; polypectomy without electrocautery) has spread rapidly worldwide during the past decade in what has been called "Cold Revolution". We performed a PubMed literature search for studies investigating CSP outcomes for colorectal polyps. Five randomized controlled trials (RCTs) assessed the complete resection rates (CRRs). The CRRs were similar regardless of the presence or absence of electrocautery, and the efficacy of submucosal injection for better CRRs is still controversial. Eight RCTs assessed the adverse events. The incidence of intraprocedural bleeding with cold procedures was comparable to or higher than that of hot procedures. The incidences of delayed bleeding were comparable to or lower with cold procedures, especially in patients taking anticoagulants. Fifteen studies have been reported on CSP for large (≥1 cm) colorectal polyps (10 retrospective studies, four prospective single-arm studies, and one prospective RCT). These studies reported that the safe cold procedures (a low intra-and post-procedural bleeding rate without perforation) could be implemented for lesions ≥1 cm. However, considering the incision depth of CSP and the local recurrence rate based on the current evidence, only large sessile serrated lesions (SSLs) can be candidates for cold procedures, and large adenomas should not be candidates for this procedure. Based on the current evidence, CSP seems to be the appropriate standard procedure for sub-centimeter colorectal low-grade adenomas due to its safety and simplicity. Thus, large SSLs can be candidates for cold procedures; however, careful inspection and further prospective studies are warranted to confirm the procedure's clinical relevance.

Hemostasis using purse‐string reefing with endoscopic clip and endoloop for a huge hematoma after cold snare polypectomy

“…In the present report, the remaining submucosal layer likely became the covering film and caused the formation of a huge nodular hematoma. However, there have been no reports of complications of huge hematoma after CSP 5 . Although it is extremely rare, the possibility of severe bleeding after CSP should be taken into consideration, regardless of the low risk of delayed bleeding.…”

Underwater endoscopic mucosal resection for colorectal lesions: Can it be an “Underwater” revolution?

“…Nevertheless, cold snare polypectomy (CSP), a polypectomy procedure without electrocautery, has had a large impact on clinical practice because of its efficacy 2 and safety, 3 leading to the so‐called “Cold Revolution”. 4 Underwater endoscopic mucosal resection (UEMR), initially reported in 2012, 5 was also expected to have a great impact. UEMR was reported to be effective in the treatment of duodenal polyps.…”

Snare devices with thinner loop wire may provide higher performance for cold snare polypectomy in an experimental model

“…It enables resection of polyps with less damage to residual tissue sur-rounding the resected lesion. Specifically, cold snare polypectomy has been reported to prevent bleeding and perforations compared to conventional endoscopic resection using electrical hot wire [9,10]. Recently, besides its use for colon polyps, cold snare polypectomy has been reported to be effective for duodenal polyps [11][12][13].…”